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Cardiac Arrest Arrhythmias

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Cardiac Arrhythmias

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Abstract

Cardiac arrest (CA) is a clinical condition defined by the absence of an effective circulatory blood flow due to the inability of the heart to provide consistent hemodynamic support.

Two main characteristics challenge the treatment of CA: its unpredictable onset and the very short time in which to intervene in order to avoid irreversible and dramatic organ damage.

The cardiology community has attempted to address the difficulties related to the management of CA through the development of standardized protocols aimed at treating CA. The current guidelines place strong consideration on the initial rhythm and the restoration of spontaneous circulation with resuscitation. What is not sufficiently emphasized in the current approach to CA is the dynamic transition of different cardiac rhythms during the acute event. In this chapter, the temporal sequence of different cardiac arrhythmias during CA and their prognostic significance are described. The proarrhythmic effects of pharmacological and electrical treatment utilized during the resuscitation are also discussed. In recent years, therapeutic hypothermia has been introduced for the treatment of survivors of CA in an effort to reduce neurological damage. Electrocardiographic abnormalities associated with therapeutic hypothermia are briefly described.

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References

  1. The European resuscitation Council Guidelines for resuscitation. 2010. Available from: http://resuscitation-guidlines.articlesmotion.com/resource-center.

  2. Nichol G, Stiell IG, Laupacis A, Pham B, De Maio VJ, Wells GA. A cumulative meta-analysis of the effectiveness of defibrillator-capable emergency medical services for victims of out-of-hospital cardiac arrest. Ann Emerg Med. 1999;34(4 Pt 1):517–25.

    Article  CAS  PubMed  Google Scholar 

  3. Grasner JT, Meybohm P, Fischer M, Bein B, Wnent J, Franz R, et al. A national resuscitation registry of out-of-hospital cardiac arrest in Germany-a pilot study. Resuscitation. 2009;80(2):199–203.

    Article  PubMed  Google Scholar 

  4. Grmec S, Krizmaric M, Mally S, Kozelj A, Spindler M, Lesnik B. Utstein style analysis of out-of-hospital cardiac arrest–bystander CPR and end expired carbon dioxide. Resuscitation. 2007;72(3):404–14.

    Article  PubMed  Google Scholar 

  5. Chugh SS, Reinier K, Teodorescu C, Evanado A, Kehr E, Al Samara M, et al. Epidemiology of sudden cardiac death: clinical and research implications. Prog Cardiovasc Dis. 2008;51(3):213–28.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Cummins RO, Chamberlain D, Hazinski MF, Nadkarni V, Kloeck W, Kramer E, et al. Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital ‘Utstein style’. American Heart Association. Circulation. 1997;95(8):2213–39.

    Article  CAS  PubMed  Google Scholar 

  7. Eisenberg MS, Cummins RO, Damon S, Larsen MP, Hearne TR. Survival rates from out-of-hospital cardiac arrest: recommendations for uniform definitions and data to report. Ann Emerg Med. 1990;19(11):1249–59.

    Article  CAS  PubMed  Google Scholar 

  8. Martens PR, Russell JK, Wolcke B, Paschen H, Kuisma M, Gliner BE, et al. Optimal Response to Cardiac Arrest study: defibrillation waveform effects. Resuscitation. 2001;49(3):233–43.

    Article  CAS  PubMed  Google Scholar 

  9. White RD, Russell JK. Refibrillation, resuscitation and survival in out-of-hospital sudden cardiac arrest victims treated with biphasic automated external defibrillators. Resuscitation. 2002;55(1):17–23.

    Article  PubMed  Google Scholar 

  10. van Alem AP, Post J, Koster RW. VF recurrence: characteristics and patient outcome in out-of-hospital cardiac arrest. Resuscitation. 2003;59(2):181–8.

    Article  PubMed  Google Scholar 

  11. Skogvoll E, Eftestol T, Gundersen K, Kvaloy JT, Kramer-Johansen J, Olasveengen TM, et al. Dynamics and state transitions during resuscitation in out-of-hospital cardiac arrest. Resuscitation. 2008;78(1):30–7.

    Article  PubMed  Google Scholar 

  12. Meaney PA, Nadkarni VM, Kern KB, Indik JH, Halperin HR, Berg RA. Rhythms and outcomes of adult in-hospital cardiac arrest. Crit Care Med. 2010;38(1):101–8.

    Article  PubMed  Google Scholar 

  13. Hallstrom A, Rea TD, Mosesso Jr VN, Cobb LA, Anton AR, Van Ottingham L, et al. The relationship between shocks and survival in out-of-hospital cardiac arrest patients initially found in PEA or asystole. Resuscitation. 2007;74(3):418–26.

    Article  PubMed  Google Scholar 

  14. Salcido DD, Stephenson AM, Condle JP, Callaway CW, Menegazzi JJ. Incidence of rearrest after return of spontaneous circulation in out-of-hospital cardiac arrest. Prehosp Emerg Care. 2010;14(4):413–8.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Neset A, Nordseth T, Kramer-Johansen J, Wik L, Olasveengen TM. Effects of adrenaline on rhythm transitions in out-of-hospital cardiac arrest. Acta Anaesthesiol Scand. 2013;57(10):1260–7.

    Article  CAS  PubMed  Google Scholar 

  16. Bourque D, Daoust R, Huard V, Charneux M. beta-Blockers for the treatment of cardiac arrest from ventricular fibrillation? Resuscitation. 2007;75(3):434–44.

    Article  CAS  PubMed  Google Scholar 

  17. Pires LA, Hull ML, Nino CL, May LM, Ganji JR. Sudden death in recipients of transvenous implantable cardioverter defibrillator systems: terminal events, predictors, and potential mechanisms. J Cardiovasc Electrophysiol. 1999;10(8):1049–56.

    Article  CAS  PubMed  Google Scholar 

  18. Luceri RM, Habal SM, Castellanos A, Thurer RJ, Waters RS, Brownstein SL. Mechanism of death in patients with the automatic implantable cardioverter defibrillator. Pacing Clin Electrophysiol. 1988;11(11 Pt 2):2015–22.

    Article  CAS  PubMed  Google Scholar 

  19. Kelly PA, Cannom DS, Garan H, Mirabal GS, Harthorne JW, Hurvitz RJ, et al. The automatic implantable cardioverter-defibrillator: efficacy, complications and survival in patients with malignant ventricular arrhythmias. J Am Coll Cardiol. 1988;11(6):1278–86.

    Article  CAS  PubMed  Google Scholar 

  20. Mercando AD, Furman S, Johnston D, Frame R, Brodman R, Kim SG, et al. Survival of patients with the automatic implantable cardioverter defibrillator. Pacing Clin Electrophysiol. 1988;11(11 Pt 2):2059–63.

    Article  CAS  PubMed  Google Scholar 

  21. Mitchell LB. Use of the implantable cardioverter-defibrillator in patients with coronary artery spasm as the apparent cause of spontaneous life-threatening ventricular tachycardia or ventricular fibrillation: crossing the spasm sudden death chasm. J Am Coll Cardiol. 2012;60(10):914–6.

    Article  PubMed  Google Scholar 

  22. Van Vleet JF, Tacker Jr WA, Geddes LA, Ferrans VJ. Acute cardiac damage in dogs given multiple transthoracic shocks with a trapezoidal wave-form defibrillator. Am J Vet Res. 1977;38(5):617–26.

    PubMed  Google Scholar 

  23. Tedeschi CG, White Jr CW. A morphologic study of canine hearts subjected to fibrillation, electrical defibrillation and manual compression. Circulation. 1954;9(6):916–21.

    Article  CAS  PubMed  Google Scholar 

  24. Tsuji Y. Electrical storm and calcium signaling: a review. J Electrocardiol. 2011;44(6):725–9.

    Article  PubMed  Google Scholar 

  25. Tsuji Y, Hojo M, Voigt N, El-Armouche A, Inden Y, Murohara T, et al. Ca(2+)-related signaling and protein phosphorylation abnormalities play central roles in a new experimental model of electrical storm. Circulation. 2011;123(20):2192–203.

    Article  CAS  PubMed  Google Scholar 

  26. Lesigne C, Levy B, Saumont R, Birkui P, Bardou A, Rubin B. An energy-time analysis of ventricular fibrillation and defibrillation thresholds with internal electrodes. Med Biol Eng. 1976;14(6):617–22.

    Article  CAS  PubMed  Google Scholar 

  27. Chen PS, Shibata N, Dixon EG, Martin RO, Ideker RE. Comparison of the defibrillation threshold and the upper limit of ventricular vulnerability. Circulation. 1986;73(5):1022–8.

    Article  CAS  PubMed  Google Scholar 

  28. Oku K, Kuboyama K, Safar P, Obrist W, Sterz F, Leonov Y, et al. Cerebral and systemic arteriovenous oxygen monitoring after cardiac arrest. Inadequate cerebral oxygen delivery. Resuscitation. 1994;27(2):141–52.

    Article  CAS  PubMed  Google Scholar 

  29. Hypothermia after Cardiac Arrest Study G. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346(8):549–56.

    Article  Google Scholar 

  30. Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346(8):557–63.

    Article  PubMed  Google Scholar 

  31. Lebiedz P, Meiners J, Samol A, Wasmer K, Reinecke H, Waltenberger J, et al. Electrocardiographic changes during therapeutic hypothermia. Resuscitation. 2012;83(5):602–6.

    Article  PubMed  Google Scholar 

  32. Riaz A, Hieb H, Foley B, Mulvihill N, Crean P, Murphy RT, et al. Safety of therapeutic hypothermia in post VF/VT cardiac arrest patients. Ir Med J. 2013;106(2):55–6.

    CAS  PubMed  Google Scholar 

  33. Piktel JS, Jeyaraj D, Said TH, Rosenbaum DS, Wilson LD. Enhanced dispersion of repolarization explains increased arrhythmogenesis in severe versus therapeutic hypothermia. Circ Arrhythm Electrophysiol. 2011;4(1):79–86.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Huang CH, Tsai MS, Hsu CY, Chen WJ. Images in cardiovascular medicine. Therapeutic hypothermia-related torsade de pointes. Circulation. 2006;114(14):e521–2.

    Article  PubMed  Google Scholar 

  35. Wu ET, Huang SC, Chi NH, Lin MT, Ko WJ, Wang SS, et al. Idioventricular rhythm induced by therapeutic hypothermia. Resuscitation. 2008;76(3):471–3.

    Article  PubMed  Google Scholar 

  36. Richter S, Ehrlich JR, Fassbender S, Fichtlscherer S. Malignant Osborn waves during therapeutic hypothermia. Europace. 2009;11(5):668–9.

    Article  PubMed  Google Scholar 

  37. Khan JN, Prasad N, Glancy JM. QTc prolongation during therapeutic hypothermia: are we giving it the attention it deserves? Europace. 2010;12(2):266–70.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada

    Riccardo Proietti, Jacqueline Joza & Vidal Essebag

  2. Department of Emergency, Central University Emergency Military Hospital “Dr Carol Davila”, Bucarest, Romania

    Florea Costea & Mihai Toma

  3. Faculty of Medicine, Titu Maiorescu University, Bucarest, Romania

    Dan Mǎnǎstireanu

Authors
  1. Riccardo Proietti
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  2. Jacqueline Joza
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  3. Florea Costea
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  4. Mihai Toma
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  5. Dan Mǎnǎstireanu
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  6. Vidal Essebag
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Corresponding author

Correspondence to Riccardo Proietti .

Editor information

Editors and Affiliations

  1. Department of Cardiology, Center Hospitalier Coutances, Coutances, France

    Ambrose S. Kibos

  2. Department of Internal Medicine Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Bradley P. Knight

  3. Division of Cardiology, McGill University Health Center, Montreal, Québec, Canada

    Vidal Essebag

  4. Department of Cardiology, Miami Children's Hospital, Miami, Florida, USA

    Steven B. Fishberger

  5. School of Biology, Chemistry and Health, Manchester Metropolitan University, Manchester, United Kingdom

    Mark Slevin

  6. “Acad. Vasile Candea” Emergency Clinical Center for Cardiovascular Diseases, “Carol Davila” University of Medicine and Pharmacy, “Titu Maiorescu” University Faculty of Medicine,, Bucharest, Romania

    Ion C. Țintoiu

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© 2014 Springer-Verlag London

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Proietti, R., Joza, J., Costea, F., Toma, M., Mǎnǎstireanu, D., Essebag, V. (2014). Cardiac Arrest Arrhythmias. In: Kibos, A., Knight, B., Essebag, V., Fishberger, S., Slevin, M., Țintoiu, I. (eds) Cardiac Arrhythmias. Springer, London. https://doi.org/10.1007/978-1-4471-5316-0_21

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  • DOI: https://doi.org/10.1007/978-1-4471-5316-0_21

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5315-3

  • Online ISBN: 978-1-4471-5316-0

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