Latest news with #suddenCardiacArrest
Medscape
6 days ago
- Health
- Medscape
Future Shock: Preventing Sudden Cardiac Death Is Possible
For patients with certain cardiovascular conditions and risk factors, sudden cardiac arrest is more than a theoretical concern. But over the past 25 years, the development of various types of defibrillators — at-home, implantable, wearable — can give the immediate shock needed if a patient at high risk goes into ventricular arrythmia. The approach is saving lives, but not enough; implantable devices have complications and most wearable devices can't be worn all the time. Stories of 'if only' tragedies abound, like that of patients who suffered sudden cardiac death while in the shower, their wearable device hanging inches away on the hook of the bathroom door. Cardiologists who study sudden cardiac death say closing the gap is possible, with attention to several critical shortcomings. Determining Risk The first, and most important, area for improvement is understanding of who is likely to experience a sudden cardiac event. About 80% of sudden cardiac arrests globally are related to coronary artery disease, said Eloi Marijon, MD, a cardiovascular and cardiac electrophysiology specialist at the European Georges Pompidou Hospital in Paris, France, who coauthored a 2023 report of a Lancet Commission calling for multidisciplinary action to reduce the global burden of sudden cardiac death. But the number of patients with the condition who eventually have an arrest is low, said Kumar Narayanan, MD, a cardiologist and electrophysiologist at Medicover Hospitals in Hyderabad, India, and a coauthor of the Lancet Commission document. 'As of now, we do not have good tools to screen and identify those people,' said Narayanan. 'We need much better prediction, which will translate to better prevention.' (A related story on Medscape Medical News looks at sudden cardiac arrest in people with no history of heart problems.) Patients with 'advanced markers of damage' — such as heart failure with reduced ejection fraction or a high fibrotic burden and certain characteristics of fibrosis — are at highest risk, he said. Acute myocardial infarction and coronary artery bypass grafting also can raise risk temporarily. In fact, risk is 'dynamic,' varying over time, he said, making predicting arrest particularly challenging. Although Narayanan calls current prediction methods 'imperfect,' known risk factors are helping cardiologists provide appropriate patients with a growing selection of devices to deliver shocks when and where an arrest occurs. Home Is Where the Heart Stops Having an automated external defibrillator (AED) at home, where most arrests happen, has been an option for patients at risk since the 1980s. But studies of home AEDs have shown mixed results. A 2013 study found the use of AEDs at home by laypeople to be safe and effective, leading to the survival of two thirds of patients who received defibrillation. But a 2008 randomized controlled study found no benefit from home AEDs over cardiopulmonary resuscitation performed by emergency medical services in high-risk patients. The value of implantable cardioverter-defibrillators (ICDs) for patients who have heart failure with reduced ejection fraction has been shown in studies since the late 1990s. Current guidelines from American and European groups recommend ICDs for the primary prevention of sudden cardiac arrest and death in these patients. In both guidelines, recommendations are class 1A, indicating strong support by high-quality evidence of a clear benefit. ICDs are usually a permanent solution, but not a perfect one, said Marijon, a cardiovascular and cardiac electrophysiology specialist at the European Georges Pompidou Hospital in Paris, France, and a coauthor of the Lancet Commission report. 'An ICD for life has a 100% chance of complications,' Marijon said. Studies show ICDs may incorrectly administer shocks when there is no arrest, and intravascular leads may fail or become infected, requiring surgical intervention. Efforts are underway to improve these devices, but industry and researchers should collaborate to develop models that protect patients yet have fewer complications, he added. Newer options for patients at high risk include cardiac resynchronization therapy, which involves the implantation of a biventricular pacemaker, and catheter ablation, which can correct certain arrythmias associated with risk for sudden cardiac arrest, although its ability to prevent arrest is unclear. Wear That Defibrillator For patients who have a transiently high risk for arrest after acute myocardial infarction or coronary artery bypass grafting or who are waiting for ICD implantation, wearable cardioverter-defibrillators are an option. LifeVest, a wearable device for sudden cardiac arrest that detects ventricular tachyarrhythmias and administers a shock to correct them, was first tested in the WEARIT and BIROAD studies, as reported in 2004. Those studies showed a beneficial effect in treating arrests. But when LifeVest was assessed in patients who had experienced a recent myocardial infarction in a 2018 major randomized controlled trial, the difference between it and regular care was not significantly different. However, a later analysis of the 2018 trial data showed that LifeVest was effective, both statistically and clinically, in patients who used it as intended. Questions of effectiveness aside, using the vest as intended has proven difficult for patients. Compliance issues have dogged the ability of wearable devices to prevent sudden cardiac arrest. 'It's the Achilles heel for all of them,' said Emile Daoud, MD, an electrophysiologist at the TriHealth Heart and Vascular Institute in Cincinnati. 'The question is not whether they work; the science of defibrillation we have figured out pretty well. Acceptance is really the problem.' False alarms, inappropriate shocks, and discomfort are frequent complaints with LifeVest, which is the only commercially available wearable cardioverter-defibrillator. New devices have been designed to improve compliance. The ASSURE wearable device has been shown to have a low rate of false alarms. Jewel, a lightweight wearable cardioverter-defibrillator, uses a patch placed over the heart and a box worn on the side of the torso to monitor cardiac activity and restore normal function. Unlike other wearable products, it can be worn in the shower and during exercise or sleep, which can improve compliance and avoid tragedies like the sudden cardiac arrest in the shower, said John Hummel, MD, an electrophysiologist at the Ohio State University Wexner Medical Center in Columbus, Ohio, who was the principal investigator for a 2024 study of the device. Next Generation Technology will help improve these devices, according to Narayanan and Marijon, and the quality of life and survival of patients at high risk. Recent advances in drug therapy for heart failure and ischemia should also help prevent sudden cardiac arrest, according to the Lancet Commission report. With aging populations and higher rates of coronary artery disease, all medical measures — better screening and diagnosis of cardiac diseases, improved treatments, more AEDs in homes and public places, and widespread use of implantable and wearable cardioverter-defibrillators — must be brought to bear, the report stated. 'We need some disruptive innovations in prediction and prevention,' said Narayanan, who points to artificial intelligence and machine learning as showing particular promise to better diagnose the underlying conditions and better predict the risk of arrest. But medical advances are not enough. The Lancet Commission report urges international research and collaboration, as well as awareness among the public and policymakers. 'Governments could do more,' said Simone Savastano, MD, a cardiologist at Fondazione IRCCS Policlinico San Matteo in Pavia, Italy. 'If you work with children or young men and women, you can raise a generation that is aware and is more keen to help a cardiac arrest patient.' Daoud reported receiving consulting fees or honoraria from Biosense-Webster, AltaThera, and OSU EP Section Educational conferences; he is the chief medical officer of S4 Medical and he has received fees from the American Board of Internal Medicine and the Journal of the American College of Cardiology. Hummelreported receiving consulting fees from Medtronic, Volta Medical, S4 Medical, Abbott Medical, and Element Science. Marijon disclosed receiving grants from Abbott, Biotronik, Boston Scientific, Medtronic, MicroPort, and Zoll; consulting fees from Medtronic, Boston Scientific, Zoll, and Abbott; and payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Medtronic, Boston Scientific, Zoll, and Abbott. Narayanan and Savastano reported no relevant financial conflicts of interest.
Medscape
16-06-2025
- Health
- Medscape
Sudden Cardiac Arrest Is Highly Preventable: Here's How
This transcript has been edited for clarity. This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women's Hospital. I'd like to talk with you about a recent report in the Canadian Journal of Cardiology that addressed the modifiable risk factors for sudden cardiac arrest, the extent to which this outcome is preventable, and the percentage of cases that could be averted by changes in modifiable risk factors. There's been surprisingly little research on this subject. Most of the research on sudden cardiac arrest has looked at genetic factors and clinical risk factors that are managed with pharmacologic agents, such as hypertension, high cholesterol, and diabetes, and proximate risk factors like what the patient was doing shortly before the sudden cardiac arrest. However, there's been very little research on the role of behavioral and lifestyle factors in long-term studies. It's important to have this research because we know that sudden cardiac arrest is highly fatal in about 90% of cases. In the US alone, there are more than 200,000 cases per year, and more than double that if we include total cardiac arrest inside and outside of the hospital. In the present study, researchers leveraged the large-scale UK Biobank, which included more than 500,000 participants whose mean age was 56 years and about 50% of whom were women. Over a follow-up of 14 years, there were about 3100 cases of incident sudden cardiac arrest. The researchers looked at about 125 risk factors and linked 56 of those factors to the risk for sudden cardiac arrest. These included lifestyle, behavioral, adiposity, psychosocial, and environmental factors. What they found was that the American Heart Association Life's Essential 8 factors were generally strongly related to risk for sudden cardiac arrest. For example, sedentary lifestyle, higher adiposity, higher waist circumference, short sleep duration (less than 7 hours per night), and tobacco use were associated with an increased risk. Other factors that were also linked to sudden cardiac arrest risk included psychosocial factors (eg, depressive symptoms, low mood, social isolation), dietary factors (eg, low fruit and vegetable intake), and air pollution. The researchers used Mendelian randomization to evaluate the likelihood of a causal relationship. In these analyses, about nine factors were determined to be causally related. These factors included adiposity factors, low fruit intake, low educational level, and some of the mood-related factors. Overall, they estimated that between 40% and 63% of sudden cardiac arrest cases could be preventable by reducing or even fully eliminating these risk factors. These findings underscore the importance of primary prevention, not only to nonfatal or total coronary heart disease and cardiovascular events, but also to sudden cardiac arrest. These results suggest that more could be done in terms of informing our patients about these risk factors in order to lower their risk — both informing them in the clinic and through community-based and public health campaigns.
Fox News
29-05-2025
- General
- Fox News
When 2-year-old goes into cardiac arrest, parents take life-saving action
Most parents of toddlers worry about sleep habits and sniffles, but heart failure isn't usually a concern. It certainly wasn't on the Thomases' radar when their 2-year-old son went into sudden cardiac arrest in the middle of the night at their Illinois home. When the child woke up screaming, his parents ran into the room. "Hearing him scream out was alarming, as he usually slept soundly, and it was a horrible cry," Stephanie Thomas told Fox News Digital. "When I went into his room, he continued to scream out and then face-plant into his crib." At first, the Thomases thought their son was just having a night terror, so Stephanie — who is a clinical dietitian at OSF HealthCare Children's Hospital of Illinois — sat next to his crib with her hand on his back, trying to calm him down. "When he finally settled, I could feel his breathing slowly come to a stop," she recalled. "I picked him up out of his crib and placed him on the floor. With him being unresponsive, I felt for a pulse and started CPR." "I was petrified and confused about how my seemingly healthy 2-year-old was in this situation." "I was petrified and confused about how my seemingly healthy 2-year-old was in this situation." As Stephanie performed CPR, her husband, Kris, called 911. Emergency responders rushed the boy to OSF HealthCare. After 11 days of testing, he was diagnosed with Brugada syndrome, a very rare heart condition that can cause sudden cardiac arrest and death. Though there can be some signs of Brugada syndrome, such as fainting or passing out, the condition is often not discovered until cardiac arrest occurs. The Thomases' son had a similar incident about a month before the cardiac arrest, which they now believe may have been his first episode. "He woke up in the middle of the night with a horrible scream, had some gasping and was hard to calm," Stephanie recalled. "It was only a short period, and once he calmed, he seemed 'normal.' We assumed it was a night terror." As Brugada syndrome is often inherited, the Thomases were both tested for genetic abnormalities, but it was determined that their son's syndrome is a "mosaic defect," which is when there are two or more genetically different sets of cells in the body. The OSF team implanted the young boy with an EV-ICD (extravascular implantable cardioverter-defibrillator), which is positioned outside the heart's blood vessels. It is designed to detect and correct any abnormal heart rhythms. This was the first time the device was implanted in a child at such a young age, the hospital noted in a press release. Since the first episode, the Thomases' son has been hospitalized six more times. Each time an abnormal heart rhythm is detected, the EV-ICD delivers a "life-saving shock" to the boy's heart. "Our son acts and appears healthy more than 99% of the time, until his heart gets into an arrhythmia that his body and medication cannot manage on their own," Stephanie told Fox News Digital. "In these cases, he receives a shock from his ICD." The boy has been readmitted to the hospital due to arrhythmias and medication titration seven times since his initial discharge, his mother added. Sunita Ferns, M.D., a pediatric electrophysiologist at OSF HealthCare Saint Francis Medical Center who is treating the Thomases' son, noted that her young patient is now "married to cardiology." "We monitor these devices constantly. If we see any arrhythmia in the background, despite the medication he's on, we can offer him other technologies," Dr. Ferns said in the OSF press release. "Ablative technologies can help modify the substrate, which is the tissue that's responsible for the bad rhythm." To help control his arrhythmias, the boy also takes a compounded oral medication every six hours, which he will take for the rest of his life. The parents said it can be challenging to navigate the episodes with a 2-year-old who can't understand what's happening. "The hardest part is when he says things like, 'I can't use the elephant blankie because it shocked me,'" Stephanie said. "He makes these associations between being shocked and the objects or places around him." There are specific triggers for the boy's arrhythmias, the Thomases have learned, such as low-grade fevers and even slight illnesses, like a cold. "It is vital that we keep him as healthy as we can — which can be challenging with him being an active 2-year-old and having a 4-year-old," Stephanie said. "We make sure that he stays up to date on his and our whole family's vaccines. We do our best to tightly regulate any temperatures." "It is vital that we keep him as healthy as we can." The Thomases now aim to raise awareness of the importance of having CPR training, being alert to warning signs and putting an emergency plan in place. As a healthcare employee, Stephanie has maintained her Basic Life Support (BLS) certification for over 10 years. For more Health articles, visit "I have always said that I work with doctors and nurses, so felt that this was something I would never use — but the doctors and nurses were not in my house the night my son went into cardiac arrest, so it was left to me."
