• Resuscitation · Aug 2019

    Early recurrent arrhythmias after out-of-hospital cardiac arrest associated with obstructive coronary artery disease: Analysis of the PROCAT registry.

    • Hugo Bellut, Lucie Guillemet, Wulfran Bougouin, Julien Charpentier, Ben Hadj Salem Omar O Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France., Jean-François Llitjos, Marine Paul, Sandrine Valade, Shirley Spagnolo, Lionel Lamhaut, Jean-Daniel Chiche, Eloi Marijon, Frédéric Pène, Olivier Varenne, Jean-Paul Mira, Florence Dumas, and Alain Cariou.
    • Medical Intensive Care Unit, Cochin Hospital (APHP), Paris, France.
    • Resuscitation. 2019 Aug 1; 141: 81-87.

    ObjectiveAfter out-of-hospital cardiac arrest (OHCA) associated with obstructive coronary artery disease (CAD), the risk of recurrence during the early period is unclear and the indication for anti-arrhythmic treatment is debated. We assessed the incidence and predisposing factors for severe cardiac arrhythmias in this population.DesignRetrospective study in a cardiac arrest center.SettingsThe primary endpoint was the occurrence of major cardiac arrhythmias from hospital admission to intensive care unit (ICU) discharge in patients admitted after an OHCA associated with obstructive CAD. A major arrhythmia was defined as any arrhythmic event (auricular or ventricular) associated with cardiac arrest recurrence and/or severe arterial hypotension. Secondary outcomes were time from ICU admission to arrhythmia occurrence and all-cause in-ICU mortality. Risk factors for recurrence of a major arrhythmia were assessed using multivariate analysis.PatientsWe included all consecutive OHCA patients resuscitated from ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) as initial rhythm associated with obstructive CAD, and who had a successful primary percutaneous coronary intervention.InterventionNone.Measurements And Main ResultsAmong 256 patients, a major arrhythmia occurred in 29 (11.3%), within the first 24 h in 79.3% of cases and were mostly VF (44.8%). Mortality rate was significantly increased in patients with major arrhythmia recurrence (69% vs 41%; p = 0.006). Factor significantly associated with recurrence of severe arrhythmia was male gender (OR 0.32 [0.12-0.92]; p = 0.034). Treatment with prophylactic anti-arrhythmic in the ICU was not associated with a change in the risk of recurrence (OR 0.85 [0.21-3.65], p = 0.82).ConclusionAn early recurrence of major arrhythmia was observed in more than 10% of post-cardiac arrest patients. These events happened mostly within the first 24 h. The interest of prophylactic anti-arrhythmic treatment remains to be evaluated in this population.Copyright © 2019 Elsevier B.V. All rights reserved.

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