Success changes the problem: Why ventricular fibrillation is declining, why pulseless electrical activity is emerging, and what to do about it

Parish, David C.; Chandra, Kailash; Dane, Francis C.

doi:10.1016/s0300-9572(03)00104-7

Cited by 60 publications

(23 citation statements)

References 27 publications

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“…The increase in the proportion of PEA cases 2,6 and corresponding decline in proportion of VF [1][2][3]6,15,16 is now a well-established phenomenon. Although the reasons for this altered trend are not clear, this is unlikely to be a function of response time for resuscitation.…”

Section: Discussionmentioning

confidence: 99%

“…Published studies suggest that the rise in PEA prevalence, on the other hand, could be related to a variety of tissue hypoxic/anoxic insults. 6 However, there is a need for comprehensive studies that extend beyond first-responder analysis and evaluate detailed lifetime clinical history and characteristics of patients. An improved understanding of factors associated with PEA could enhance the current understanding of mechanisms.…”

Section: Clinical Perspective On P 2122mentioning

confidence: 99%

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Factors Associated With Pulseless Electric Activity Versus Ventricular Fibrillation

et al. 2010

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Background— Corresponding with a continuing decline in the prevalence of sudden cardiac arrest cases presenting with ventricular fibrillation (VF), there has been a significant rise in the prevalence of pulseless electrical activity (PEA). Given significantly lower survival from PEA versus VF, we comprehensively investigated PEA correlates by incorporating first-responder data with lifetime clinical history information. Methods and Results— In the Portland, Ore, metropolitan area (population ≈1 million), cases of out-of-hospital sudden cardiac arrest who underwent attempted resuscitation were identified prospectively (2002–2007). Those presenting with PEA versus VF and asystole were compared with χ 2 tests, ANOVA, and logistic regression. A total of 1277 cases aged ≥18 years underwent resuscitation by first responders (mean age, 65±16 years; 67% male). Presenting arrhythmia was VF in 48%, PEA in 25%, and asystole/other in the remainder. Compared with VF cases, PEA cases were older (mean age, 68 versus 63 years; P =0.0002), more likely to be female (37% versus 26%; P =0.0008), and less likely to survive to hospital discharge (6% versus 25%; P <0.0001). A history of syncope was strongly associated with PEA (odds ratio, 2.6; confidence interval, 1.3 to 5.3) after adjustment for age, gender, response time, and arrest circumstances. Black race was also independently associated with PEA (odds ratio, 2.6; confidence interval, 1.3 to 5.4). Pulmonary disease and female gender were significant factors associated with PEA ( P for interaction=0.04). In a subgroup analysis of resting ECGs (n=391), there were no differences in cardiac clinical history or prevalence of cardiac conduction system disease (PEA, 31.6% versus VF, 32.2%; P =0.48). Conclusions— PEA cases had a significantly higher prevalence of syncope in their lifetime, with other correlates, including black race, that were distinct from VF cases. Potential mechanistic links between syncope and future manifestation with PEA warrant further exploration.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Perspective On P 2122mentioning

confidence: 99%

Factors Associated With Pulseless Electric Activity Versus Ventricular Fibrillation

et al. 2010

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“…13,14 The incidence of sudden cardiac death by any cause other than ventricular fibrillation increases in patients with low cardiac function. 15,16 An ICD is effective for terminating ventricular tachyarrhythmias and restore sinus rhythm, but it is not useful for pulseless electrical activity. 12 Therefore, we should not place too much confidence in the ICD.…”

Section: Discussionmentioning

confidence: 99%

Are the MADIT II Criteria for ICD Implantation Appropriate for Japanese Patients?

Tanno

Miyoshi

Watanabe

et al. 2005

Circ J

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“…What are the causes of this altered prevalence and why is it important? It is possible that VF is more commonly related to coronary disease and PEA to non-cardiac factors such as lung disease (35). As a consequence the decline in VF prevalence may have occurred due to the significant decrease in age-adjusted mortality from coronary artery disease over the last 50 years (36).…”

Section: Presenting Arrhythmia In Patients Who Suffer Sudden Cardiac mentioning

confidence: 99%

Epidemiology of Sudden Cardiac Death: Clinical and Research Implications

Chugh

Reinier

Teodorescu

et al. 2008

Progress in Cardiovascular Diseases

597

458

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The current annual incidence of sudden cardiac death in the US is likely to be in the range of 180-250,000 per year. Coinciding with the decreased mortality from coronary artery disease, there is evidence pointing toward a significant decrease in rates of sudden cardiac death in the US during the second half of the twentieth century. However the alarming rise in prevalence of obesity and diabetes in the first decade of the new millennium both in the US and worldwide, would indicate that this favorable trend is unlikely to persist. We are likely to witness a resurgence of coronary artery disease and heart failure, as a result of which sudden cardiac death will have to be confronted as a shared and indiscriminate, worldwide public health problem. There is also increasing recognition of the fact that discovery of meaningful and relevant risk stratification and prevention methodologies will require careful prospective community-wide analyses, with access to large archives of DNA, serum and tissue that link with well-phenotyped databases. The purpose of this review is to summarize current knowledge of sudden cardiac death epidemiology. We will discuss the significance and strengths of community-wide evaluations of sudden cardiac death, summarize recent observations from such studies, and finally highlight specific potential predictors that warrant further evaluation as determinants of sudden cardiac death in the general population.

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Success changes the problem: Why ventricular fibrillation is declining, why pulseless electrical activity is emerging, and what to do about it

Cited by 60 publications

References 27 publications

Factors Associated With Pulseless Electric Activity Versus Ventricular Fibrillation

Factors Associated With Pulseless Electric Activity Versus Ventricular Fibrillation

Are the MADIT II Criteria for ICD Implantation Appropriate for Japanese Patients?

Epidemiology of Sudden Cardiac Death: Clinical and Research Implications

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