Background: The purpose of this study was to determine the causes and the prognosis of consecutive patients resuscitated from cardiac arrest occurring in a general hospital. We assessed 28 females and 94 males (aged 13-82 years) who were resuscitated from cardiac arrest not attributable to acute myocardial infarction. Ventricular fibrillation (VF) was documented in 97. Non-cardiac causes were excluded. Non-invasive studies (24 h Holter monitoring, 2D echocardiogram, signal-averaged ECG, exercise testing, magnetic resonance imaging) and invasive studies (right and left ventricular angiography, coronary angiography and complete electrophysiologic study (EPS) were performed. Results: An underlying cardiac disease was found in 107 patients (88%). Patients were followed for a period ranging from 6 months to 10 years (mean 4±5 years). Several causes for cardiac arrest were identified and treated specifically. The prognosis was variable. Among surviving patients the following causes of cardiac arrest were found: Wolff-Parkinson-White syndrome (n = 2), rapid supraventricular tachycardia (n = 6), acquired or congenital long QT syndrome (n = 7), complete atrioventricular block (n = 3), proarrhythmic effect of an antiarrhythmic drug (n = 5), vasospastic angina (normal coronary arteries) (n = 5). Among ten patients with VF related to cardiac ischaemia two died suddenly. Ventricular tachycardia (VT) or VF was the main cause leading to resuscitation after cardiac arrest (n = 64). The risk of recurrence of arrest is confirmed in the present study particularly in patients in whom VT/VF could not be suppressed by antiarrhythmic drug therapy (n = 45) and in those where an ICD was not implanted (18 cardiac deaths (nine sudden cardiac deaths (SCD's)). The cause of cardiac arrest was not elucidated in 20 patients (16%). The prognosis of these patients differed according to the documentation of VF at the time of cardiac arrest: of those with documented VF (n = 12), six patients died suddenly (one with an ICD); of those without documented VF (n = 8), all are alive. Conclusion: To determine the precise cause of cardiac arrest was the first problem; the diagnosis of cardiac arrest clearly was erroneous in 8 of 122 patients (6.5%). In other patients, a ventricular tachyarrhythmia was identified as the cause for cardiac arrest in half of the population; the indication for an ICD is evident in this group. In 31% of patients with proven cardiac arrest, another arrhythmia requiring specific treatment was identified and ICD implantation was avoided; these patients had a survival of 92% at 3 years. In patients without an identified cause of cardiac arrest and negative EPS, the prognosis was unfavorable only in those with documented VF.

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   |texte=   Causes and prognosis of cardiac arrest in a population admitted to a general hospital; a diagnostic and therapeutic problem
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