Implantable cardioverter defibrillator therapy for primary prevention of sudden cardiac death in the real world: Main findings from the French multicentre DAI-PP programme (pilot phase)

This review summarizes the main findings of the French multicentre DAI-PP pilot programme, and discusses the related clinical and research perspectives. This project included retrospectively (2002–2012 period) more than 5000 subjects with structural heart disease who received an implantable cardioverter defibrillator (ICD) for primary prevention of sudden cardiac death, and were followed for a mean period of 3 years. The pilot phase of the DAI-PP programme has provided valuable information on several practical and clinically relevant aspects of primary prevention ICD implantation in the real-world population, which are summarized in this review. This pilot has led to a prospective evaluation that started in May 2018, assessing ICD therapy in primary and secondary prevention in patients with structural and electrical heart diseases, with remote monitoring follow-up using a dedicated platform. This should further enhance our understanding of sudden cardiac death, to eventually optimize the field of preventative actions

P4167Non-shockable rhythm related sudden cardiac arrest in the community

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&lt;0.001), with greater proportion of females (34.9 vs. 19.2%, P&lt;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&lt;0.001) but the proportion of chest pain was lower (24.0 vs. 43.3%, P&lt;0.001). Survival rate was much lower in non-shockable rhythm cases (7.2 vs. 42.3%, P&lt;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. </jats:sec

P2827Different views of sudden cardiac arrest characteristics according to the assessed population

Abstract Background Survival rate remains extremely low in sudden cardiac arrest (SCA) and death may occur at all stages of its management. We hypothesized that different medical care providers have different visions of the SCA population characteristics. Purpose To assess SCA characteristics among four groups: all-comers SCA, resuscitated SCA, SCA admitted alive to intensive care unit (ICU), and SCA admitted to cardiology. Methods Data was taken from the Paris Sudden Cardiac Death Expertise Center prospective registry that includes all adults presenting SCA in Paris and suburbs (6.7 millions). We compared SCA characteristics according to the management phase where the population was assessed. Results Of 18,622 out-of-hospital cardiac arrests occurring between 2011 and 2016, 15,207 fulfilled SCA criteria and had known resuscitation status. Among them, 9,721 SCA (63.9%) underwent resuscitation, leading to 3,349 SCA (22.0%) admitted to ICU, then 735 (4.8%) admitted to Cardiology. Mean age was highest in the global population (70.7yrs), and decreased progressively throughout the phases to 57.0yrs in cardiology (P&lt;0.001). Ratio of male victims and rates of witnessed SCA and bystanders' cardiopulmonary resuscitation and automated external defibrillator use increased gradually (all P&lt;0.001). No flow duration decreased by a third (9.1min overall to 3.0min in cardiology, P&lt;0.001). The rate of shockable initial rhythm increased drastically, from 19.5% overall to 26.8% in resuscitated patients, 48.9% in ICU-admitted SCA, and 89.4% in cardiology-admitted (Table). Sudden cardiac arrests characteristics Entire SCA population SCA with attempted resuscitation SCA admitted to ICU SCA admitted to Cardiology P value n=15,207 n=9,721 n=3349 n=735 Age (years ± SD) 70.7±16.9 65.8±16.1 59.7±15.7 57.0±14.5 &lt;0.001 Male sex, n (%) 9,353 (61.6) 6607 (68.0) 2395 (71.5) 599 (81.5) &lt;0.001 Home location, n (%) 12,297 (81.1) 7075 (73.0) 1906 (56.9) 269 (36.6) &lt;0.001 Bystander, n (%) 10,546 (71.2) 7545 (78.7) 3037 (90.7) 715 (97.3) &lt;0.001 Bystander CPR, n (%) 5,684 (39.1) 4504 (47.7) 2120 (63.5) 583 (81.2) &lt;0.001 Public AED use, n (%) 155 (1.0) 142 (1.5) 116 (3.5) 51 (6.9) &lt;0.001 No flow, (min ± SD) 9.1±12.5 7.5±10.4 5.3±6.6 3.0±3.8 &lt;0.001 EMS call-to-arrival delay, (min ± SD) 10.2±5.8 10.1±5.7 10.1±6.1 9.6±6.4 0.068 Initial Shockable rhythm, n (%) 2,643 (19.5) 2529 (26.8) 1635 (48.9) 657 (89.4) &lt;0.001 SCA: sudden cardiac arrest; AED: automated external defibrillator; CPR: cardiopulmonary resuscitation; EMS: emergency medical service; ICU: intensive care unit. Conclusion Characteristics of SCA change considerably according to the assessed population, leading to different views on SCA reality. Keeping in mind the SCA population considered is paramount for a non-biased view of SCA. </jats:sec