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Christopher C Cheung, Andrew D Krahn, The importance of a comprehensive evaluation of survivors of cardiac arrest, European Heart Journal, Volume 39, Issue 21, 01 June 2018, Pages 1988–1991, https://doi.org/10.1093/eurheartj/ehy160
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This editorial refers to ‘Characteristics and clinical assessment of unexplained sudden cardiac arrest in the real-world setting: focus on idiopathic ventricular fibrillation’†, by V. Waldmann et al., on page 1981.
In the absence of structural heart disease, an apparently unexplained cardiac arrest includes an eclectic compilation of latent causes, including long QT syndrome, Brugada syndrome, early repolarization syndrome, and several structural causes. After comprehensive assessment, about half of patients with unexplained cardiac arrest will have a specific aetiology identified, with the remaining indeterminate cases labelled ‘idiopathic ventricular fibrillation’ (IVF).1 In this issue of the journal, Waldmann et al. report the medical evaluation and outcomes among a Parisian cohort of 717 cardiac arrest survivors, focusing on those patients who remained undiagnosed after diagnostic testing.2 Among patients labeled IVF (49 patients), only 16% received a comprehensive assessment, defined as cardiac magnetic resonance (CMR), ergonovine challenge, and pharmacological testing. Although most patients underwent CMR (82%), genetic testing was performed in less than one-fifth and exercise testing in less than one-tenth of individuals. Importantly, family screening occurred in less than a quarter of patients. The authors’ findings highlight the importance of a comprehensive systematic evaluation of cardiac arrest survivors, and gaps in the current delivery of guideline-directed unexplained cardiac arrest assessment.
