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European Journal of Pediatrics

, Volume 178, Issue 9, pp 1333–1342 | Cite as

Significance of automated external defibrillator in identifying lethal ventricular arrhythmias

  • Takeshi TsudaEmail author
  • Elaine M. Geary
  • Joel Temple
Original Article

Abstract

Automated electrical defibrillator (AED) is critical in saving children who develop unexpected cardiac arrest (CA), but its diagnostic capacity is not fully acknowledged. Retrospective cohort study of patients with aborted sudden cardiac death (SCD) was performed. Twenty-five patients (14 males) aged 1.3 to 17.5 years who presented with CA survived with prompt cardiopulmonary resuscitation. Eighteen patients had no prior cardiac diagnosis. Cardiac arrest occurred in 10 patients with more than moderate exercise, in 7 with light exercise, and in 8 at rest (including one during sleep). Twenty-two patients were resuscitated with AED, all of which were recognized as a shockable cardiac rhythm. Thorough investigations revealed 6 ion channelopathies (4 catecholaminergic polymorphic ventricular tachycardia, one long QT syndrome, and one Brugada syndrome), 5 congenital heart disease (including 2 with coronary artery obstruction), 6 cardiomyopathies, 2 myocarditis, and 2 miscellaneous. Four patients had no identifiable heart disease. In 5 patients, the downloaded AED-recorded rhythm strip delineated the underlying arrhythmias and their responses to electrical shocks. Four patients who presented with generalized seizure at rest were initially managed for seizure disorder until AED recording identified lethal ventricular arrhythmias.

Conclusions: AED reliably identifies the underlying lethal ventricular arrhythmias in addition to aborting SCD.

What is Known:

Although infrequent in children, sudden cardiac death (SCD) is often an unexpected and tragic event. The etiology is diverse and sometimes remains unknown despite extensive investigations.

Automated external defibrillator (AED) is both therapeutic in aborting SCD and diagnostic in identifying the underlying lethal ventricular arrhythmias. However, the diagnostic aspect of AED is under-acknowledged by most medical providers.

What is New:

Four of 25 patients (16%) were initially managed for possible seizure disorders until AED recording identified lethal ventricular arrhythmia.

The AED recording of the lethal arrhythmia during cardiopulmonary resuscitation (CPR) should always be obtained as it plays a crucial role in the decision-making process before ICD implantation. All medical providers should become familiar with downloading cardiac rhythm strips from AED when requested.

Keywords

Automated external defibrillator (AED) Cardiac arrest (CA) Implantable cardioverter defibrillator (ICD) Sudden cardiac death (SCD) Sudden acute death syndrome (SADS) Ventricular fibrillation (VF) 

Abbreviations

AED

Automated external defibrillator

CA

Cardiac arrest

CPR

Cardiopulmonary resuscitation

CT

Computed tomography

ECG

Electrocardiogram

ED

Emergency department

EMT

Emergency medical technician

EST

Exercise stress test

HCM

Hypertrophic cardiomyopathy

ICD

Implantable cardioverter defibrillator

LQTS

Long QT syndrome

LVOT

LV outflow tract

MRI

Magnetic resonance imaging

SADS

Sudden arrhythmic death syndrome

SCD

Sudden cardiac death

VF

Ventricular fibrillation

VT

Ventricular tachycardia

Notes

Acknowledgments

The authors thank Ms. Rosemary Alumbugh, RN, for her clerical support.

Authors’ contributions

T. T. conceptualized and designed this retrospective study, collected and organized the data, wrote the manuscript, and revised the manuscript according to the co-authors’ feedback. E. G. reviewed the individual patient charts in detail and collected the data. J. T. is in charge of ICD clinic who provided critical information regarding AED recording and patients’ profiles, carefully examined the provided data, and critically read the manuscript. All authors read and approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Takeshi Tsuda
    • 1
    • 2
    Email author
  • Elaine M. Geary
    • 1
  • Joel Temple
    • 1
    • 2
  1. 1.Nemours Cardiac CenterNemours/Alfred I. duPont Hospital for ChildrenWilmingtonUSA
  2. 2.Department of Pediatrics, Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaUSA

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