Dr. Krahn is a Career Investigator of the Heart and Stroke Foundation of Ontario (CI6498). Dr. Gollob is a Clinician Scientist of the Heart and Stroke Foundation of Ontario. The study was supported by the Heart and Stroke Foundation of Ontario (T6730), and an unrestricted research grant from Boston Scientific. Dr. Sanatani reports compensation for speaking on sudden death. Other authors: No disclosures.
Sentinel Symptoms in Patients with Unexplained Cardiac Arrest: From the Cardiac Arrest Survivors with Preserved Ejection Fraction Registry (CASPER)
Article first published online: 28 SEP 2011
© 2011 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 23, Issue 1, pages 60–66, January 2012
How to Cite
KRAHN, A. D., HEALEY, J. S., SIMPSON, C. S., CHAUHAN, V. S., BIRNIE, D. H., CHAMPAGNE, J., GARDNER, M., SANATANI, S., CHAKRABARTI, S., YEE, R., SKANES, A. C., LEONG-SIT, P., AHMAD, K., GOLLOB, M. H., KLEIN, G. J., GULA, L. J. and SHELDON, R. S. (2012), Sentinel Symptoms in Patients with Unexplained Cardiac Arrest: From the Cardiac Arrest Survivors with Preserved Ejection Fraction Registry (CASPER). Journal of Cardiovascular Electrophysiology, 23: 60–66. doi: 10.1111/j.1540-8167.2011.02185.x
- Issue published online: 17 JAN 2012
- Article first published online: 28 SEP 2011
- Manuscript received 29 May 2011; Revised manuscript received 3 July 2011; Accepted for publication 21 July 2011.
- cardiac arrest;
Sentinel Symptoms in Unexplained Cardiac Arrest. Background: Warning symptoms may provide an opportunity to diagnose genetic disorders leading to preventative therapy. We explored the symptom history of patients with apparently unexplained cardiac arrest to determine the frequency of sentinel symptoms.
Methods: Patients with apparently unexplained cardiac arrest and no evident cardiac disease underwent systematic clinical evaluation. Patients and first-degree relatives were interviewed to determine the presence of cardiac symptoms, and those with syncope underwent 2 structured Calgary Syncope Score questionnaires to determine the probable mechanism of syncope.
Results: One hundred consecutive cardiac arrest patients (age 43.0 ± 13.4 years, 60% male) and 63 first-degree relatives (age 37.6 ± 16.3 years, 54% female) were enrolled. Previous cardiac symptoms were present in 69% of cardiac arrest patients compared to 43% of family members (P = 0.001). Prior syncope was present in 26% of cardiac arrest patients, compared to 22% of family members (P = 0.59). Twenty-four of 25 cardiac arrest patients who completed the syncope questionnaires had a syncope versus seizure score <1 favoring syncope. The area under the receiver operator curve (ROC) for the syncope mechanism score was 0.79 for identifying patients with subsequent cardiac arrest (95% CI, 0.6328–0.9395, P = 0.004). A score of ≤–2 had a sensitivity of 68% and specificity of 85%. Thirty percent of patients with a proven genetic cause had preceding syncope versus 19% in patients with noninherited or idiopathic causes (P = 0.032).
Conclusions: Syncope that may represent a sentinel event is present in a modest proportion of patients and family members, and is often suggestive of an arrhythmia. (J Cardiovasc Electrophysiol, Vol. 23, pp. 60-66, January 2012)