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Significance of automated external defibrillator in identifying lethal ventricular arrhythmias

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A Correspondence to this article was published on 22 October 2019

Abstract

Automated electrical defibrillator (AED) is critical in saving children who develop unexpected cardiac arrest (CA), but its diagnostic capacity is not fully acknowledged. Retrospective cohort study of patients with aborted sudden cardiac death (SCD) was performed. Twenty-five patients (14 males) aged 1.3 to 17.5 years who presented with CA survived with prompt cardiopulmonary resuscitation. Eighteen patients had no prior cardiac diagnosis. Cardiac arrest occurred in 10 patients with more than moderate exercise, in 7 with light exercise, and in 8 at rest (including one during sleep). Twenty-two patients were resuscitated with AED, all of which were recognized as a shockable cardiac rhythm. Thorough investigations revealed 6 ion channelopathies (4 catecholaminergic polymorphic ventricular tachycardia, one long QT syndrome, and one Brugada syndrome), 5 congenital heart disease (including 2 with coronary artery obstruction), 6 cardiomyopathies, 2 myocarditis, and 2 miscellaneous. Four patients had no identifiable heart disease. In 5 patients, the downloaded AED-recorded rhythm strip delineated the underlying arrhythmias and their responses to electrical shocks. Four patients who presented with generalized seizure at rest were initially managed for seizure disorder until AED recording identified lethal ventricular arrhythmias.

Conclusions: AED reliably identifies the underlying lethal ventricular arrhythmias in addition to aborting SCD.

What is Known:

• Although infrequent in children, sudden cardiac death (SCD) is often an unexpected and tragic event. The etiology is diverse and sometimes remains unknown despite extensive investigations.

• Automated external defibrillator (AED) is both therapeutic in aborting SCD and diagnostic in identifying the underlying lethal ventricular arrhythmias. However, the diagnostic aspect of AED is under-acknowledged by most medical providers.

What is New:

• Four of 25 patients (16%) were initially managed for possible seizure disorders until AED recording identified lethal ventricular arrhythmia.

• The AED recording of the lethal arrhythmia during cardiopulmonary resuscitation (CPR) should always be obtained as it plays a crucial role in the decision-making process before ICD implantation. All medical providers should become familiar with downloading cardiac rhythm strips from AED when requested.

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Abbreviations

AED:

Automated external defibrillator

CA:

Cardiac arrest

CPR:

Cardiopulmonary resuscitation

CT:

Computed tomography

ECG:

Electrocardiogram

ED:

Emergency department

EMT:

Emergency medical technician

EST:

Exercise stress test

HCM:

Hypertrophic cardiomyopathy

ICD:

Implantable cardioverter defibrillator

LQTS:

Long QT syndrome

LVOT:

LV outflow tract

MRI:

Magnetic resonance imaging

SADS:

Sudden arrhythmic death syndrome

SCD:

Sudden cardiac death

VF:

Ventricular fibrillation

VT:

Ventricular tachycardia

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Acknowledgments

The authors thank Ms. Rosemary Alumbugh, RN, for her clerical support.

Author information

Authors and Affiliations

  1. Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA

    Takeshi Tsuda, Elaine M. Geary & Joel Temple

  2. Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    Takeshi Tsuda & Joel Temple

Authors
  1. Takeshi Tsuda
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  2. Elaine M. Geary
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  3. Joel Temple
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Contributions

T. T. conceptualized and designed this retrospective study, collected and organized the data, wrote the manuscript, and revised the manuscript according to the co-authors’ feedback. E. G. reviewed the individual patient charts in detail and collected the data. J. T. is in charge of ICD clinic who provided critical information regarding AED recording and patients’ profiles, carefully examined the provided data, and critically read the manuscript. All authors read and approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Takeshi Tsuda.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard.

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The authors declare that they have no conflict of interest.

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Communicated by Peter de Winter

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Revisions received: 21 June 2019 / 24 June 2019

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Tsuda, T., Geary, E.M. & Temple, J. Significance of automated external defibrillator in identifying lethal ventricular arrhythmias. Eur J Pediatr 178, 1333–1342 (2019). https://doi.org/10.1007/s00431-019-03421-9

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  • DOI: https://doi.org/10.1007/s00431-019-03421-9

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