BRADYCARDIA AT ONSET OF SUDDEN-DEATH - POTENTIAL MECHANISMS
BRADYCARDIA AT ONSET OF SUDDEN-DEATH - POTENTIAL MECHANISMS
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DOI：
10.1111/j.1749-6632.1984.tb20788.x
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发表时间：
1984-01-01
影响因子：
5.2
通讯作者：
GREENBERG, HM
中科院分区：
文献类型：
--
作者：
GREENBERG, HM
Ventricular fibrillation receives most of the attention in analysis of sudden death or malignant ventricular arrhythmias. The substantive contribution of bradycardia has not received widespread attention or intensive scrutiny. Our interest in bradycardiac rhythms was stimulated by six deaths monitored by Holter tapes that were collected over a two-year period. These recordings showed four terminal bradycardic events and two cases of ventricular fibri1lation. l In a review of Holter-monitored deaths from 1974-1981, Nikolic2 reported 4 of 21 cases to be bradycardic or asystolic. In out-of-hospital sudden death, the studies of the occurrence of bradycardic or asystolic cardic arrest reveal an incidence of 16-31 per~ ent.~-~ Iseri4 reported that 25% of out-ofhospital cardiac arrests treated within 10 minutes of collapse were bradycardic or asystolic, and of these, only 30% were noncoronary mechanisms. Myerburg et aL6 reported that 31% of 352 out-of-hospital cardiac arrest patients had a bradycardic or asystolic rhythm when found by paramedics. Of these 108 patients, 99 died en route to the hospital or in the emergency ward, and none survived to hospital discharge. Patients found in ventricular fibrillation fared much better: forty percent survived into the hospital and 59% of those patients were discharged alive. Unfortunately, autopsy data are not available for this study, but several observations seem pertinent. These patients died suddenly; the bradycardia was not an agonal rhythm following a protracted course. A subset of these patients reached by paramedics within four minutes of onset of symptoms had survival characteristics similar to that of the entire group. Also, there was no difference in the arrival time of the paramedics for the bradycardic or tachycardic deaths. who developed out-ofhospital sudden bradyasystolic death is shown in FIGURE 1. The patient was an 84-year-old practicing attorney with a history of a prior myocardial infarction who had his first syncopal episode the day prior to this recording. His physician found no changes in his physical exam or resting electrocardiogram and did not change his medical regimen of propranolol and procainamide. Sinus tachycardia at approximately 110 beats per minute for 30 minutes preceded the terminal arrhythmia that lasted 1% minutes. The terminal arrhythmia showed alterations in atrioventricular conduction, ST segments, and T waves prior to the final bradycardic asystole. A plausible hypothesis is that these bradycardic patients die of an acute cardiac catastrophe for which an explanation is currently lacking. Therefore, we need to search for mechanisms in order to learn how to deal with or prevent this rhythm disorder. The aims of this paper are to illustrate that neither the frequency nor the severity of the well-recognized clinical settings
