Clinical evaluation of unselected cardiac arrest survivors in a tertiary center over a 1-year period (the LAZARUZ study)

• This study describes prospective cardiac arrest survivors admitted to a tertiary center in Copenhagen during a 1-year period
• Patients underwent extensive evaluation, however, many patients (37%) did not receive a diagnosis
• Family history did not predict etiology among cardiac arrest survivors
• In 9 of 16 patients categorized as ‘idiopathic ventricular fibrillation’ supplemental ECG recordings suggested the presence of channelopathies as the cause of the cardiac arrest
• Performing the ‘brisk standing’ test to induce postural sinus tachycardia and ‘elevation of precordial leads V1–2’ may be reasonable diagnostic tricks among cardiac arrest survivors in whom no diagnosis can be reached despite extensive evaluation

ObjectivesWhen the cause of an aborted cardiac arrest is unclear the initiation of therapy, counseling and family screening is challenging.MethodsWe included 43 unselected, prospectively identified cardiac arrest survivors with or without a diagnosis. Family history for cardiac disease and supplemental electrocardiograms were evaluated for additional diagnostic information.Results43 cardiac arrest survivors were included, 34 (79%) were male and the average age was 48 years (range 23–64, SD 13.0). The most common etiologies identified in cardiac arrest survivors were ischemic heart disease (33%), cardiomyopathies (14%), miscellaneous (e.g. drug induced arrhythmias, coronary spasms) (12%) and channelopathies (5%). Family history of cardiac disease – even inheritable conditions – was not indicative of etiology in cardiac arrest survivors. Supplemental ECGs were abnormal in 10 of 43 patients; in the majority of these patients (7) no conclusive diagnosis was reached.ConclusionsIn this study 16/43 (37%) of unselected, prospectively included cardiac arrest survivors remained without a diagnosis despite exhaustive investigations. We may extract additional diagnostic information from simple maneuvers during the recording of the electrocardiogram. We suggest that these ECG derived clues be investigated in future studies including genetic test results and data from relatives.