Non‐ischemic sudden cardiac arrest: Role of 12 lead Holter, family screening and genetic testing. Issue 8 (27th June 2021)

• Record Type: Journal Article
• Authors: Blich, Miry; Oron, Hodaya; Darawsha, Wisam; Suleiman, Mahmoud; Avraham, Lorber; Asaad, Kchoury; Boulos, Monther; Gepstein, Lior
• Is Part Of: Pacing and clinical electrophysiology. Volume 44:Issue 8(2021)
• Page Start: 1347
• Page End: 1354
• Publication Date: 2021-06-27
• Subjects: sudden cardiac arrest -- 12 lead Holter; Cardiac pacing -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1111/pace.14294
• Languages: English
• ISSNs: 0147-8389

Abstract

Abstract: Objective and Background: To evaluate the diagnostic and prognostic yield of a comprehensive protocol involving clinical and broad genetic testing in consecutive sudden cardiac arrest (SCA) population. Determining the pathogenesis of non‐ischemic SCA is crucial for management and SCA prevention in other family members Methods: Families with unexplained non‐ischemic SCA event underwent rigorous clinical and genetic protocol after referral to our inherited arrhythmia clinic, during 2011–2017. Results: One hundred and four index cases, 29 ± 16 years, and 421 family members were studied. After a thorough evaluation, diagnosis was made in 80 (77%) of families. The most prevalent 47/104 (45%) diagnosis was inherited channelopathy. The genetic test was positive, in 37 /69 (54%) of patients. Using the Mann Whitney test, we found that electrocardiography (ECG) (effect size 0.5, p < .001), 12 lead Holter (effect size 0.33, p = .001) and family screening (effect size 0.4, p = .001) had the highest yield in reaching the final diagnosis. Family screening, genetic testing, and cardiac MRI were the exclusive modalities for final diagnosis in 14%, 9%, and 2% of families, respectively. Among 421 family members evaluated through cascade screening, 127 (30%), were diagnosed and medically treated. Nine family members from 25 (40%) patients who underwent implantable cardioverter defibrillator (ICD) implantation have experienced appropriate ICD shock. Conclusions: A rigorous, systematic protocol in a specialized inherited arrhythmia clinic has a high diagnostic and prognostic yield. ECG, 12 lead Holter and family screening significantly increased the diagnostic yield. In nine families, without genetic testing, the diagnosis would have been missed.