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Canadian Journal of Cardiology

Out-of-Hospital Cardiac Arrest in the Presence of Ischemic Heart Disease: What Is the Long-term Arrhythmic Risk After Revascularization?

  • Nigel S. Tan
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Division of Cardiology, St Michael’s Hospital, Toronto, Ontario, Canada
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  • Paul Dorian
    Correspondence
    Corresponding author: Dr Paul Dorian, St. Michael’s Hospital, 30 Bond Street, 6-050, Toronto, Ontario M5B 1W8, Canada. Tel.: +1-416-864-5104. Fax: +1-416-864-5849.
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Division of Cardiology, St Michael’s Hospital, Toronto, Ontario, Canada
    Search for articles by this author
Published:April 05, 2018DOI:https://doi.org/10.1016/j.cjca.2018.04.001

      Abstract

      Patients resuscitated from out-of-hospital cardiac arrest (OHCA) frequently have underlying coronary artery disease (CAD), but the relationship between the arrest and myocardial ischemia or infarction due to CAD can be difficult to discern in clinical practice. Patients often present with clinical profiles that guideline recommendations for appropriate implantable cardioverter-defibrillator use do not address. In cases of incomplete revascularization or mild but sustained impairment of ventricular function, it is not clear if the cause of the cardiac arrest is completely “reversible.” We describe distinct phenotypes of patients with OHCA and concomitant CAD and highlight current knowledge gaps in their management and outcomes.

      Résumé

      Les patients réanimés après un arrêt cardiaque hors de l’hôpital (ACHH) ont souvent une coronaropathie sous-jacente, mais le lien entre l’arrêt et l’ischémie ou l’infarctus du myocarde en raison de la coronaropathie peut être difficile à reconnaître dans la pratique clinique. Les patients présentent souvent des profils cliniques pour lesquels les recommandations des lignes directrices sur l’utilisation appropriée des défibrillateurs cardioverteurs implantables ne sont pas formulées. Dans les cas de revascularisation incomplète ou de détérioration faible, mais prolongée, de la fonction ventriculaire, on ignore si la cause de l’arrêt cardiaque est complètement « réversible ». Nous décrivons les différents phénotypes des patients atteints d’une coronaropathie qui subissent un ACHH et démontrons les lacunes courantes en matière de connaissances sur leur prise en charge et leur issue.
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