Sudden cardiac death electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] José Eduardo Riceto Loyola Junior, M.D.[3] Edzel Lorraine Co, DMD, MD [4]

Overview

An electrocardiogram (ECG) may be helpful in the diagnosis of Sudden cardiac death. Findings on ECG associated with sudden cardiac arrest (SCA) include Sinus tachycardia (39%), abnormal T-wave inversions (30%), prolonged QT interval (26%), left/right atrial abnormality (22%), left ventricular hypertrophy (17%), abnormal frontal QRS axis (17%), delayed QRS-transition zone in precordial leads (13%), pathological Q waves (13%), intraventricular conduction delays (9%), multiple premature ventricular contractions (9%), normal ECG (9%).

An electrocardiogram (ECG) may be helpful in the diagnosis of Sudden cardiac death. Findings on ECG associated with sudden cardiac arrest (SCA) may include:^[1]

A recently published case report demonstrated a cardiac arrest happening due to a very unusual cause. It was triggered by the increased parasympathethic tone during defecation. The successive changes that were observed on ECG were in this order: prolonged PR interval, 2:1 atrioventricular block, sinus bradycardia and complete heart block. These findings supported the occurrence of a central mechanism in this cardiac arrest.^[2]

Recommendations for evaluation of patients presenting with newly documented ventricular arryhthmia
Class I (Level of Evidence: C)
In patients with newly documented ventricular arrhythmia (VA) (frequent premature ventricular contractions (PVCs), non-sustained ventricular tachycardia (NSVT), sustained monomorphic ventricular tachycardia (SMVT), a baseline 12-lead electrocardiogram (ECG) whenever possible, and an echocardiogram are recommended as first-line evaluation.

Recommendations for evaluation of sudden cardiac arrest survivors
Class IIa (Level of Evidence: C)
In SCA survivors, brain/ chest CT scan should be considered when patient characteristics, ECG, and echocardiography are not consistent with a cardiac cause.
Class I (Level of Evidence: B)
In SCA survivors, repeated 12-lead ECGs during stable rhythm (including high precordial lead ECG), as well as continuous cardiac monitoring are recommended.

Recommendation for management of relatives of a patient with aarhythmogenic right ventricular cardiomyopathy
Class I (Level of Evidence: C)
In a first-degree relative of a patient with ARVC, ECG and echocardiogram are recommended.

Recommendation for management of relatives of a patient with hypertrophic cardiomyopathy
Class I (Level of Evidence: C)
In a first-degree relative of a patient with HCM, ECG and echocardiogram are recommended.

Recommendation for diagnosis and management of ventricular arryhthmia in neuromuscular diseases
Class I (Level of Evidence: C)
Annual follow-up with at least 12-lead ECG is recommended in patients with muscular dystrophies, even in the concealed phase of the disease.

Class I (Level of Evidence: B)
Baseline familial evaluation of sudden arrhythmic death syndrome (SADS) decedents is recommended to include taking a medical history and performing physical examination, standard and high precordial lead ECG, echocardiography, and exercise testing.

Class I (Level of Evidence: B)
Ambulatory ECG monitoring is recommended in patients with symptoms of syncope, presyncope, palpitation suspected ventricular arrhythmia

Class of recommendation	Level of evidence	Recommendation for ECG and exercise tredmile test
1	B	In patients with wide complex tachycardia and hemodynamically stable, 12 leads ECG should be obtained
1	B	Exercise stress test should be obtained in patients suspected arrhythmia-related exercise such as ischemic heart disease or cathecolaminergic polymorphic ventricular tachycardia
1	B	In patients with documented ventricular arrhythmia, 12 leads ECG should be obtained during sinus rhythm for evaluation of underlying heart disease

↑ Jayaraman, Reshmy; Reinier, Kyndaron; Nair, Sandeep; Aro, Aapo L.; Uy-Evanado, Audrey; Rusinaru, Carmen; Stecker, Eric C.; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S. (2018). "Risk Factors of Sudden Cardiac Death in the Young". Circulation. 137 (15): 1561–1570. doi:10.1161/CIRCULATIONAHA.117.031262. ISSN 0009-7322.
↑ Tsushima T, Patel TR, Sahadevan J (2021). "Unusual Cause of Cardiac Arrest". JAMA Intern Med. 181 (4): 542–543. doi:10.1001/jamainternmed.2020.8370. PMID 33464284 Check |pmid= value (help).
↑ Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA; et al. (2022). "2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death". Eur Heart J. 43 (40): 3997–4126. doi:10.1093/eurheartj/ehac262. PMID 36017572 Check |pmid= value (help).
↑ Al-Khatib, Sana M.; Stevenson, William G.; Ackerman, Michael J.; Bryant, William J.; Callans, David J.; Curtis, Anne B.; Deal, Barbara J.; Dickfeld, Timm; Field, Michael E.; Fonarow, Gregg C.; Gillis, Anne M.; Granger, Christopher B.; Hammill, Stephen C.; Hlatky, Mark A.; Joglar, José A.; Kay, G. Neal; Matlock, Daniel D.; Myerburg, Robert J.; Page, Richard L. (2018). "2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death". Circulation. 138 (13). doi:10.1161/CIR.0000000000000549. ISSN 0009-7322.