RESUMO
BACKGROUND: Asystole (ASY) and pulseless electrical activity (PEA) have a poor outcome during sudden cardiac arrest (SCA). Psychotropic medication has been associated with a risk for sudden cardiac death (SCD). Our aim was to study the association of psychotropic medication with ASY/PEA during SCA. METHODS AND RESULTS: A total of 659 SCA subjects were derived from the emergency data of Oulu University Hospital (2007-2012). Subjects with non-cardiac origin of SCA and over 30-minute delay to rhythm recording were excluded. Population included 222 subjects after exclusions (mean age 64 ± 14 years, 78% males). Initial rhythm was ventricular fibrillation (VF) or ventricular tachycardia (VT) in 123 (55%), ASY in 67 (30%) and PEA in 32 (14%) subjects. The delay (collapse to rhythm recording) was similar in VF/VT and ASY/PEA subjects (median 8 min [1st-3rd quartile 3-12 min] versus 10 [0-14] minutes, p = 0.780). Among VF/VT subjects underlying cardiac disease was more often ischemic compared to ASY/PEA subjects (85% versus 68%, p = 0.003). Psychotropic medication was associated with ASY/PEA rhythm (OR 3.18, 95%CI 1.40-7.23, p = 0.006) after adjustment for gender, age and underlying cardiac disease. Subsequently, antipsychotics (OR 4.27, 95%CI 1.28-14.25, p = 0.018) were more common in the ASY/PEA group. Benzodiazepines and antidepressants were not associated with ASY/PEA. CONCLUSION: Psychotropic medication and especially antipsychotics are associated with non-shockable rhythm during SCA and may lower the possibility of survival from the event. This might partly explain the risk of SCD related to psychotropic medication.
RESUMO
BACKGROUND: Asystole (ASY) and pulseless electrical activity (PEA) are increasing and ventricular fibrillation (VF) or ventricular tachycardia (VT) declining as presenting rhythms of sudden cardiac arrest (SCA). Since there is limited information on possible differences in the etiology of underlying structural heart disease, we analyzed the clinical and/or autopsy findings of victims with ASY, PEA or VT/VF. METHODS: All SCA cases with recorded ASY, PEA or VT/VF occurring after onset of witnessed collapse were analyzed by the emergency personnel between the years 2007-2012 within the Oulu University Hospital area. Underlying structural heart disease was diagnosed by medico-legal autopsy or by clinical investigation (echocardiography, angiography). Of a total number of 659 subjects with a documented rhythm at the time of SCA, 300 were determined to be due to cardiac disease at autopsy or as a result of clinical investigation. Delay was less than 30min from collapse to rhythm recording in 274 subjects (mean age 65±14 yrs; 214 males, 78.1%). RESULTS: The presenting rhythm was ASY in 87 (31.8%) PEA in 38 (13.9%) and VT/VF in 149 subjects (54.4%). There was no significant difference in the delay from the onset of collapse to the rhythm recording between ASY (11±8min) and VT/VF (9±6min, p=0.06) or PEA (6±8min) and VT/VF (p=0.334). The majority of SCA subjects had an ischemic cause for the event (n=216, 78.8%). Non-ischemic cause for SCA was associated with non-shockable rhythm (Non-ischemic: ASY 46.6% PEA 17.2% VT/VF 36.2% v. Ischemic: ASY 27.8% PEA 13.0% VT/VF 59.3%) even when adjusted for gender, age and delay from collapse to rhythm recording (ASY/PEA v. VT/VF, OR 3.2 95%CI: 1.67-6.50, p=0.001). CONCLUSIONS: Asystole and PEA are a more common presenting rhythm than VT/VF at the time of SCA in non-ischemic cardiac disease. The decreasing trend of ischemic heart disease as a cause of SCA may partly explain the increasing trend of ASY/PEA.