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Sharifzadehgan A, Gaye B, Rischard J, Bougouin W, Karam N, Waldmann V, Narayanan K, Dumas F, Gandjbakhch E, Algalarrondo V, Beganton F, Extramiana F, Lellouche N, Lamhaut L, Jost D, Cariou A, Jouven X, Marijon E. Characteristics and factors associated to patients discharging from hospital without an implantable cardioverter defibrillator after out-of-hospital cardiac arrest. Eur Heart J Acute Cardiovasc Care 2022; 11:523-531. [PMID: 35714122 DOI: 10.1093/ehjacc/zuac065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/25/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
AIMS Guidelines recommend that in the absence of reversible cause for sudden cardiac arrest (SCA), implantable cardioverter defibrillator (ICD) should be performed to prevent further fatal event. We sought to describe the frequency and characteristics of patients discharged from the hospital without ICD after the SCA in the daily practice. METHODS AND RESULTS From 2011 to 2018, all SCAs related to a cardiac cause admitted alive across the 48 hospitals of Great Paris Area were prospectively enrolled. Two investigators thoroughly reviewed each medical report to ensure accuracy of the assigned diagnosis towards identifying the cause of SCA and ICD implantation. Out of the 4314 SCA admitted alive at hospital admission, 1064 cardiac-related SCA survivors were discharged alive from hospital, including 356 patients (33.5%) with an ICD and 708 (66.5%) without. The principal underlying cause of SCA among those discharged without an ICD was acute coronary syndrome (ACS; 602, 85%), chronic coronary artery disease (41, 5.8%), structural non-ischaemic heart disease (48, 6.8%), and non-structural heart disease (17, 2.4%). Among ACS-related SCA, 93.8% (602/642) discharged without an ICD. The unique factor associated with non-ICD implantation in the setting of ACS was immediate coronary angioplasty (odds ratio 4.22, 95% confidence interval 1.86-9.30, P < 0.001). CONCLUSION Two-thirds of SCA survivors were discharged without an ICD, mainly in the setting of ACS. The unique factor associated with non-ICD implantation among ACS was immediate coronary angioplasty emphasizing the fact that ACS definition must be precise since associated with ICD implantation or not.
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Affiliation(s)
- Ardalan Sharifzadehgan
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - Bamba Gaye
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - Julien Rischard
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | - Wulfran Bougouin
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
- Jacques Cartier Hospital, Intensive Care Unit, Massy, France
| | - Nicole Karam
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - Victor Waldmann
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - Kumar Narayanan
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Medicover Hospitals, Cardiology Department, Hyderabad, India
| | - Florence Dumas
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
- Cochin Hospital, Emergency Department, Paris, France
| | - Estelle Gandjbakhch
- La Pitié Salpêtrière University Hospital, Cardiology Department, Paris, France
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), Paris, France
| | - Vincent Algalarrondo
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), Paris, France
- Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France
| | - Frankie Beganton
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | - Fabrice Extramiana
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), Paris, France
- Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France
| | - Nicolas Lellouche
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), Paris, France
- University Hospital Henri Mondor, Cardiology Department, Crèteil, France
| | - Lionel Lamhaut
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
- Paris Firefighters Brigade (BSPP), Paris, France
| | - Daniel Jost
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Paris Firefighters Brigade (BSPP), Paris, France
| | - Alain Cariou
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
- Cochin Hospital, Intensive Care Unit, Paris, France
| | - Xavier Jouven
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - Eloi Marijon
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), Paris, France
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Sharifzadehgan A, Gaye B, Bougouin W, Narayanan K, Dumas F, Karam N, Rischard J, Plu I, Waldmann V, Algalarrondo V, Gandjbakhch E, Bruneval P, Beganton Date Curation F, Alonso C, Moubarak G, Piot O, Lamhaut L, Jost D, Sideris G, Mansencal N, Deye N, Voicu S, Megarbane B, Geri G, Vieillard-Baron A, Lellouche N, Extramiana F, Wahbi K, Varenne O, Cariou A, Jouven X, Marijon E. Lack of Early Etiologic Investigations in Young Sudden Cardiac Death. Resuscitation 2022; 179:197-205. [PMID: 35788021 DOI: 10.1016/j.resuscitation.2022.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/09/2022] [Accepted: 06/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Since majority of sudden cardiac arrest (SCA) victims die in the intensive care unit (ICU), early etiologic investigations may improve understanding of SCA and targeted prevention. METHODS In this prospective, population-based registry all SCA admitted alive across the 48 hospitals of the Paris area were enrolled. We investigated the extent of early etiologic work-up among young SCD cases (<45 years) eventually dying within the ICU. RESULTS From May 2011 to May 2018, 4,314 SCA patients were admitted alive. Among them, 3,044 died in ICU, including 484 (15.9%) young patients. SCA etiology was established in 233 (48.1%) and remained unexplained in 251 (51.9%). Among unexplained (compared to explained) cases, coronary angiography (17.9 vs. 49.4%, P<0.001), computed tomography scan (24.7 vs. 46.8%, P<0.001) and trans-thoracic echocardiography (31.1 vs. 56.7%, P<0.001) were less frequently performed. Only 22 (8.8%) patients with unexplained SCD underwent all three investigations. SCDs with unexplained status decreased significantly over the 7 years of the study period (from 62.9 to 35.2%, P=0.005). While specialized TTE and CT scan performances have increased significantly, performance of early coronary angiography did not change. Autopsy, genetic analysis and family screening were performed in only 48 (9.9%), 5 (1.0%) and 14 cases (2.9%) respectively. CONCLUSIONS More than half of young SCD dying in ICU remained etiologically unexplained; this was associated with a lack of early investigations. Improving early diagnosis may enhance both SCA understanding and prevention, including for relatives. Failure to identify familial conditions may result in other preventable deaths within these families.
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Affiliation(s)
- Ardalan Sharifzadehgan
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France.
| | - Bamba Gaye
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
| | - Wulfran Bougouin
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Jacques Cartier Hospital, Intensive Care Unit, Massy, France
| | - Kumar Narayanan
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Medicover Hospitals, Cardiology Department, Hyderabad, India
| | - Florence Dumas
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France; Cochin Hospital, Emergency Department, Paris, France
| | - Nicole Karam
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
| | - Julien Rischard
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | | | - Victor Waldmann
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
| | - Vincent Algalarrondo
- Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
| | - Estelle Gandjbakhch
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.); La Pitié Salpêtrière University Hospital, Cardiology Department, Paris, France
| | - Patrick Bruneval
- University of Paris, Paris, France; European Georges Pompidou Hospital, Pathology Department, Paris, France
| | | | - Christine Alonso
- Centres Médico Chirurgicaux Ambroise Paré, Neuilly-sur-Seine, France
| | - Ghassan Moubarak
- Centres Médico Chirurgicaux Ambroise Paré, Neuilly-sur-Seine, France
| | - Olivier Piot
- Centre Cardiologique du Nord, Saint Denis, France
| | - Lionel Lamhaut
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France; Emergency Medical Services (SAMU) 75, Necker University Hospital, APHP, Paris, France
| | - Daniel Jost
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris Firefighters Brigade (BSPP), Paris, France
| | | | - Nicolas Mansencal
- Ambroise Paré Hospital, Cardiology Intensive Care Unit, Paris, France
| | - Nicolas Deye
- Lariboisiere Hospital, Intensive Care Unit, Paris, France
| | | | | | - Guillaume Geri
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Ambroise Paré Hospital, Intensive Care Unit, Paris, France
| | | | - Nicolas Lellouche
- University Hospital Henri Mondor, Cardiology Department, Créteil, France
| | - Fabrice Extramiana
- Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
| | - Karim Wahbi
- University of Paris, Paris, France; Cochin Hospital, Cardiology Intensive Care Unit, Paris, France
| | - Olivier Varenne
- University of Paris, Paris, France; Cochin Hospital, Cardiology Intensive Care Unit, Paris, France
| | - Alain Cariou
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France; Cochin Hospital, Intensive Care Unit, Paris, France
| | - Xavier Jouven
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
| | - Eloi Marijon
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
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Rischard J, Waldmann V, Moulin T, Sharifzadehgan A, Lee R, Narayanan K, Garcia R, Marijon E. Assessment of Heart Rhythm Disorders Using the AliveCor Heart Monitor: Beyond the Detection of Atrial Fibrillation. JACC Clin Electrophysiol 2021; 6:1313-1315. [PMID: 33092760 DOI: 10.1016/j.jacep.2020.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022]
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Fiorina L, Marijon E, Maupain C, Coquard C, Larnier L, Rischard J, Bourmaud A, Salerno F, Horvilleur J, Lacotte J, Ait Said M, Manenti V, Maltret A, Li J, Gardella C. 222AI-based strategy enables faster Holter ECG analysis with equivalent clinical accuracy compared to a classical strategy. Europace 2020. [DOI: 10.1093/europace/euaa162.374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Analysis of Holter recordings can be challenging and time-consuming, therefore requiring significant clinical resources in order to achieve a high-quality diagnosis. Such resources depend largely on the qualifications of the person conducting the analysis and the duration of the recordings. A novel Holter analysis platform has been developed, based on deep neural networks trained with a dataset of one million ECGs, to allow fast and reliable Holter recording analysis.
PURPOSE
This study sought to compare the performance of an artificial intelligence (AI)-based Holter analysis platform using deep learning tools with a classical one used on a daily basis in hospitals (the reference). The main endpoints evaluated were duration to complete the analysis by the physician operating it as well as diagnostic accuracy of each strategy, when platforms are used by electrophysiologists (EPs).
METHODS
For this prospective evaluation, a total of 159 Holter recordings (24-hour) were selected from a large Holter dataset from 1 hospital, with a relatively high prevalence of electrical rhythm and conduction disorders. Recordings were analysed by four EPs using independently both the AI-based and classical analysis platforms. All four EPs had no previous experience with the AI-based platform, except for an introductory 6-hour training session. Three EPs had multiple years of experience with the traditional platform, while one EP had limited experience. For each recording, in addition to the analysis duration, diagnostic accuracy was evaluated through the analysis of the presence or absence of predefined cardiac arrhythmias and conduction disorders (prevalence): pauses (25.2%), ventricular tachycardia (VT, 30.2%), atrial fibrillation (AF, 26.4%), high grade atrioventricular block (AVB, 10.1%) and burden of premature ventricular complex larger than 10% (PVC, 23.9%). Definite diagnostics were established by an expert EP after a careful examination of all available analysis reports.
RESULTS
Time required for the AI-based analysis was on average 42% shorter compared to the traditional platform (6.65 min vs 11.5 min, p < 0.0001). Regarding accuracy to detect electrical disorders, there was no statistically significant differences between AI-based and classical platforms (AF: 98.7% vs 96.9%, Pause: 99.4% vs 100%, PVC: 98.7% vs 98.7%, VT: 92.5% vs 96.2%, AVB: 98.7% vs 94.3%). CONCLUSION: These preliminary findings suggest that an AI-based strategy to analyse Holter recordings may be highly accurate in detecting cardiac electrical abnormalities, with significant time savings compared to a classical strategy, even for users with no previous experience with the novel AI-based platform. An AI-based Holter analysis platform may contribute to a broader and more resource-efficient adoption of Holter monitoring.
Abstract Figure. analysis duration using each strategy
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Affiliation(s)
- L Fiorina
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - E Marijon
- European Hospital Georges Pompidou, Cardiology, Paris, France
| | - C Maupain
- PITIE SALPETRIERE APHP UNIVERSITY HOSPITAL, electrophysiology, Paris, France
| | - C Coquard
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - L Larnier
- PITIE SALPETRIERE APHP UNIVERSITY HOSPITAL, electrophysiology, Paris, France
| | - J Rischard
- European Hospital Georges Pompidou, Cardiology, Paris, France
| | - A Bourmaud
- University Paris Diderot , Paris, France
| | - F Salerno
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - J Horvilleur
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - J Lacotte
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - M Ait Said
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - V Manenti
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - A Maltret
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - J Li
- Cardiologs Techologies, Paris, France
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Waldmann V, Karam N, Rischard J, Bougouin W, Sharifzadehgan A, Dumas F, Narayanan K, Sideris G, Voicu S, Gandjbakhch E, Jost D, Lamhaut L, Ludes B, Plu I, Beganton F, Wahbi K, Varenne O, Megarbane B, Algalarrondo V, Extramiana F, Lellouche N, Celermajer DS, Spaulding C, Lafont A, Cariou A, Jouven X, Marijon E. Low rates of immediate coronary angiography among young adults resuscitated from sudden cardiac arrest. Resuscitation 2020; 147:34-42. [PMID: 31857140 DOI: 10.1016/j.resuscitation.2019.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 11/27/2022]
Abstract
AIM Coronary artery disease (CAD) has recently been emphasized as a major cause of sudden cardiac arrest (SCA) in young adults. We aim to assess the rate of immediate coronary angiography performance in young patients resuscitated from SCA. METHODS From May 2011 to May 2017, all cases of out-of-hospital SCA aged 18-40 years alive at hospital admission were prospectively included in 48 hospitals of the Great Paris area. Cardiovascular causes of SCA were centrally adjudicated, and management including immediate coronary angiography performance was assessed. RESULTS Out of 3579 SCA admitted alive, 409 (11.4%) patients were under 40 years of age (32.3 ± 6.2 years, 69.7% males), with 244 patients having a definite cause identified. Among those, CAD accounted for 72 (29.5%) cases, of which 64 (88.9%) were acute coronary syndromes. The rate of immediate coronary angiography was only 41.7% compared to 65.1% among those ≥40-years (P < 0.001). During the study period, while the rate of immediate coronary angiography increased from 60.5% to 70.3% (P < 0.001) in patients aged ≥40 years, the rate in patients aged less than 40 years remained stable (43.5% to 45.3%, P = 0.795). Patients younger than 40 years were significantly less likely to undergo immediate coronary angiography (OR = 0.34, 95% CI: 0.25-0.47), although early angiography was associated with survival at hospital discharge (OR = 2.68, 95% CI: 1.21-6.00). CONCLUSION CAD is the first cause of SCA in young adults aged less than 40 years. The observed low rates of immediate coronary angiography suggest a missed opportunity for early intervention.
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Affiliation(s)
- Victor Waldmann
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France
| | - Nicole Karam
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France
| | - Julien Rischard
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | - Wulfran Bougouin
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; Ramsay Générale de Santé, Hôpital privé Jacques Cartier, Intensive Care Unit, Massy, France
| | - Ardalan Sharifzadehgan
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France
| | - Florence Dumas
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; AP-HP, Cochin-Hotel Hospital, Emergency Department, Paris, France
| | - Kumar Narayanan
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Medicover Hospitals, Hyderabad, India
| | - Georgios Sideris
- AP-HP, Lariboisière Hospital, Cardiology Department, Paris, France
| | - Sebastian Voicu
- AP-HP, Lariboisière Hospital, Intensive Care Unit, Paris, France
| | - Estelle Gandjbakhch
- AP-HP, La Pitié Salpêtrière University Hospital, Cardiology Department, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France
| | | | | | | | - Isabelle Plu
- AP-HP, La Pitié Salpêtrière University Hospital, Anatomopathology Department, Paris, France
| | - Frankie Beganton
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | - Karim Wahbi
- Paris University, Paris, France; AP-HP, Cochin Hospital, Cardiology Department, Paris, France
| | - Olivier Varenne
- Paris University, Paris, France; AP-HP, Cochin Hospital, Cardiology Department, Paris, France
| | - Bruno Megarbane
- AP-HP, Lariboisière Hospital, Intensive Care Unit, Paris, France
| | - Vincent Algalarrondo
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France; AP-HP, Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France
| | - Fabrice Extramiana
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France; AP-HP, Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France
| | - Nicolas Lellouche
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France; AP-HP, Henri Mondor Hospital, Cardiology Department, Créteil, France
| | | | - Christian Spaulding
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris University, Paris, France
| | - Antoine Lafont
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris University, Paris, France
| | - Alain Cariou
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; AP-HP, Cochin Hospital, Intensive Care Unit, Paris, France
| | - Xavier Jouven
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France
| | - Eloi Marijon
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France.
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Sharifzadehgan A, Rischard J, Bougouin W, Dumas F, Waldmann V, Beganton F, Aissaoui N, Géri G, Jost D, Lamhaut L, Cariou A, Jouven X, Marijon E. Non-shockable rhythm related sudden cardiac arrest in the community. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rischard J, Narayanan K, Garcia R, Marijon E. [Prevention of sudden cardiac death and implantable cardioverter defibrillators: Understanding the competitive risk!]. Presse Med 2019; 48:1401-1405. [PMID: 31699540 DOI: 10.1016/j.lpm.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 08/27/2019] [Accepted: 09/09/2019] [Indexed: 12/13/2022] Open
Abstract
Sudden cardiac death represents a major public health issue, with up to 50% of the cardiovascular mortality. Coronary artery disease and dilated cardiomyopathy both represent almost 90% of sudden cardiac death burden. Primary prevention using implantable cardioverter defibrillator relies, in this population, on the left ventricle ejection fraction simple measurement. In this paper, we aim to discuss in which extent a better understanding of competing risk situation may help for a better patient selection and eventually for optimizing primary prevention using implantable cardioverter defibrillator.
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Affiliation(s)
- Julien Rischard
- Hôpital Européen Georges-Pompidou, département de cardiologie, unité de rythmologie, 75015 Paris, France
| | | | - Rodrigue Garcia
- CHU de Poitiers, unité de rythmologie, 86000, Poitiers, France
| | - Eloi Marijon
- Hôpital européen Georges-Pompidou, département de cardiologie, unité de rythmologie, 20, rue Leblanc, 75908 Paris cedex 15, France.
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Sharifzadehgan A, Rischard J, Bougouin W, Dumas F, Waldmann V, Beganton F, Aissaoui N, Geri G, Jost D, Lamhaut L, Cariou A, Jouven X, Marijon E. P4167Non-shockable rhythm related sudden cardiac arrest in the community. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
A significant increase in the prevalence of sudden cardiac arrest (SCA) with non-shockable rhythm has been reported, related to asystole and pulseless electrical activity (PEA). Factors associated with non-shockable rhythm and the mode to the return of spontaneous circulation (ROSC) may help for a better understanding.
Purpose
We aimed to describe the frequency, characteristics and outcome of SCA related to non-shockable versus shockable rhythm in the community.
Methods
In this prospective ongoing, multicentre population-based registry (6.7 million inhabitants), data from all SCA over a 5-year period were analyzed. Initial rhythm was obtained from the EMS report and the initial recorded rhythm strip when available. Medical records for each SCA were reviewed by cardiologists to identify underlying aetiology and associated conditions.
Results
Among the 3,028 SCAs admitted alive out of a total of 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 2,904 patients had available information regarding initial rhythm at the time of EMS arrival. Among them, 1,314 patients (45.3%) presented with non-shockable rhythm: 1,109 (38.2%) cases with asystole, 197 (6.8%) with PEA and 8 (0.3%) with high degree atrioventricular block.
Cases with non-shockable rhythm were older (60.6 vs. 57.4 years, P<0.001), with greater proportion of females (34.9 vs. 19.2%, P<0.001) and less proportion of family history of coronary artery disease or SCA. Proportion of warning symptoms prior to the SCA was higher among patients with non-shockable rhythm (74.3 vs. 64.9%, P<0.001) but the proportion of chest pain was lower (24.0 vs. 43.3%, P<0.001). Survival rate was much lower in non-shockable rhythm cases (7.2 vs. 42.3%, P<0.001).
Among the 1,314 non-shockable cases eventually admitted alive to hospital, 1,022 (77.8%) did not require external defibrillation prior to ROSC, and a majority (91.7%) received adrenaline during resuscitation. In this subgroup, the main identified cardiac cause was acute coronary syndrome (45.3%), followed by chronic CAD (27.1%), structural non-ischemic heart disease (22.4%), and non-structural heart disease (5.2%).
Conclusions
Initial non-shockable rhythm is encountered in almost half of SCA cases admitted alive; mostly occurs in older patients with higher proportion of females. Over three quarters of these cases did not require external defibrillation prior to ROSC.
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Affiliation(s)
| | - J Rischard
- European Hospital Georges Pompidou, Paris, France
| | - W Bougouin
- Paris Cardiovascular Research Center (PARCC), Paris, France
| | - F Dumas
- Hospital Cochin, Paris, France
| | - V Waldmann
- European Hospital Georges Pompidou, Paris, France
| | - F Beganton
- Paris Cardiovascular Research Center (PARCC), Paris, France
| | - N Aissaoui
- European Hospital Georges Pompidou, Paris, France
| | - G Geri
- Hopital Ambroise Pare, Intensive Care Unit, Paris, France
| | - D Jost
- Brigade des Sapeurs Pompiers de Paris, Paris, France
| | | | | | - X Jouven
- European Hospital Georges Pompidou, Paris, France
| | - E Marijon
- European Hospital Georges Pompidou, Paris, France
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Deutschmann O, Rischard J, Diehm C, Maier L. Untersuchung der Dehydrierung und der oxidativen Dehydrierung von n-Butan an Platin und V-basierten Katalysatoren in einem Zwei-Zonen-Wirbelschichtreaktor. CHEM-ING-TECH 2014. [DOI: 10.1002/cite.201450578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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