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Out-of-hospital cardiac arrest due to idiopathic ventricular fibrillation in patients with normal electrocardiograms: results from a multicentre long-term registry

Giulio Conte, Bernard Belhassen, Pier Lambiase, Giuseppe Ciconte, Carlo De Asmundis, Elena Arbelo, Beat Schaer, Antonio Frontera, Haran Burri, Leonardo Calo', Kostantinos P Letsas, Francisco Leyva, Bradley Porter, Johan Saenen, Valerio Zacà, Paola Berne, Peter Ammann, Marco Zardini, Blerim Luani, Roberto Rordorf, Georgia Sarquella Brugada, Argelia Medeiros-Domingo, Johann-Christoph Geller, Tom De Potter, Mathis K Stokke, Manlio F Márquez, Yoav Michowitz, Shohreh Honarbakhsh, Manuel Conti, Christian Sticherling, Annamaria Martino, Abbasin Zegard, Tardu Özkartal, Maria Luce Caputo, François Regoli, Rüdiger C Braun-Dullaeus, Francesca Notarangelo, Tiziano Moccetti, Gavino Casu, Christopher A Rinaldi, Moises Levinstein, Kristina H Haugaa, Nicolas Derval, Catherine Klersy, Moreno Curti, Carlo Pappone, Hein Heidbuchel, Josép Brugada, Michel Haïssaguerre, Pedro Brugada & Angelo Auricchio

abstract

AIMS 
To define the clinical characteristics and long-term clinical outcomes of a large cohort of patients with idiopathic ventricular fibrillation (IVF) and normal 12-lead electrocardiograms (ECGs).

METHODS AND RESULTS
Patients with ventricular fibrillation as the presenting rhythm, normal baseline, and follow-up ECGs with no signs of cardiac channelopathy including early repolarization or atrioventricular conduction abnormalities, and without structural heart disease were included in a registry. A total of 245 patients (median age: 38 years; males 59%) were recruited from 25 centres. An implantable cardioverter-defibrillator (ICD) was implanted in 226 patients (92%), while 18 patients (8%) were treated with drug therapy only. Over a median follow-up of 63 months (interquartile range: 25-110 months), 12 patients died (5%); in four of them (1.6%) the lethal event was of cardiac origin. Patients treated with antiarrhythmic drugs only had a higher rate of cardiovascular death compared to patients who received an ICD (16% vs. 0.4%, P = 0.001). Fifty-two patients (21%) experienced an arrhythmic recurrence. Age ≤16 years at the time of the first ventricular arrhythmia was the only predictor of arrhythmic recurrence on multivariable analysis [hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.18-0.92; P = 0.03].

CONCLUSION 
Patients with IVF and persistently normal ECGs frequently have arrhythmic recurrences, but a good prognosis when treated with an ICD. Children are a category of IVF patients at higher risk of arrhythmic recurrences.
   
citation Conte G, Belhassen B, Lambiase P, Ciconte G, de Asmundis C, Arbelo E, Schaer B, Frontera A, Burri H, Calo' L, Letsas K P, Leyva F, Porter B, Saenen J, Zacà V, Berne P, Ammann P, Zardini M, Luani B, Rordorf R, Sarquella Brugada G, Medeiros-Domingo A, Geller J C, de Potter T, Stokke M K, Márquez M F, Michowitz Y, Honarbakhsh S, Conti M, Sticherling C, Martino A, Zegard A, Özkartal T, Caputo M L, Regoli F, Braun-Dullaeus R C, Notarangelo F, Moccetti T, Casu G, Rinaldi C A, Levinstein M, Haugaa K H, Derval N, Klersy C, Curti M, Pappone C, Heidbuchel H, Brugada J, Haïssaguerre M, Brugada P, Auricchio A. Out-of-hospital cardiac arrest due to idiopathic ventricular fibrillation in patients with normal electrocardiograms: results from a multicentre long-term registry. Europace 2019; 21:1670-1677.
   
type journal paper/review (English)
date of publishing 01-11-2019
journal title Europace (21/11)
ISSN electronic 1532-2092
pages 1670-1677
PubMed 31504477
DOI 10.1093/europace/euz221