How to diagnose the cause of sudden cardiac arrest

Sudden cardiac death or sudden cardiac arrest (SCA) is defined as natural death that occurs within an hour of the onset of acute symptoms or during sleep due to a primary cardiac cause. Most cases of SCA are attributable to coronary artery disease, with occult cardiomyopathy or inheritable arrhythmic syndromes accounting for a minority of SCA. Diagnosing the cause of SCA has potential implications for the patient and the family, and demands a comprehensive approach. This review summarizes the potential causes of SCA and outlines a systematic diagnostic approach to the SCA survivor. (Cardiol J 2011; 18, 2: 210-216

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Utility of Cardiovascular Magnetic Resonance in Identifying Substrate for Malignant Ventricular Arrhythmias

Background- Sudden cardiac death (SCD) and sustained monomorphic ventricular tachycardia (SMVT) are frequently associated with prior or acute myocardial injury. Cardiovascular magnetic resonance (CMR) provides morphological, functional, and tissue characterization in a single setting. We sought to evaluate the diagnostic yield of CMR-based imaging versus non-CMR-based imaging in patients with resuscitated SCD or SMVT. Methods and Results- Eighty-two patients with resuscitated SCD or SMVT underwent routine non-CMR imaging, followed by a CMR protocol with comprehensive tissue characterization. Clinical reports of non-CMR imaging studies were blindly adjudicated and used to assign each patient to 1 of 7 diagnostic categories. CMR imaging was blindly interpreted using a standardized algorithm used to assign a patient diagnosis category in a similar fashion. The diagnostic yield of CMR-based and non-CMR-based imaging, as well as the impact of the former on diagnosis reclassification, was established. Relevant myocardial disease was identified in 51% of patients using non-CMR-based imaging and in 74% using CMR-based imaging (P=0.002). Forty-one patients (50%) were reassigned to a new or alternate diagnosis using CMR-based imaging, including 15 (18%) with unsuspected acute myocardial injury. Twenty patients (24%) had no abnormality by non-CMR imaging but showed clinically relevant myocardial disease by CMR imaging. Conclusions- CMR-based imaging provides a robust diagnostic yield in patients presenting with resuscitated SCD or SMVT and incrementally identifies clinically unsuspected acute myocardial injury. When compared with non-CMR-based imaging, a new or alternate myocardial disease process may be identified in half of these patients