Deif Bishoy, Roberts Jason D
Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario.
Pacing Clin Electrophysiol. 2019 Oct;42(10):1320-1330. doi: 10.1111/pace.13780. Epub 2019 Aug 21.
Identifying the cause of unexplained cardiac arrest is critical for appropriate management of both survivors and their family members. Aborted cardiac arrests whose cause remains unknown following investigation with a surface ECG, echocardiogram, and coronary angiogram are deemed unexplained. Many of these unexplained arrests are felt to be secondary to concealed forms of cardiac channelopathies and latent or subtle cardiomyopathies. This recognition has led to evaluating a diagnostic role for a series of additional investigations, including advanced imaging, genetic testing, and provocative forms of testing, including sodium channel blockade and treadmill testing. Despite evidence of an improved diagnostic yield through their systematic usage, clinical guidelines have yet to endorse a formal algorithm delineating investigations that must be performed before assigning a label of idiopathic ventricular fibrillation, which has resulted in markedly variables thresholds for concluding this diagnosis. Debate remains regarding the need for an invasive electrophysiology study among these patients, though identification of arrhythmic culprits requiring intracardiac electrograms for diagnostic confirmation have suggested a potential role when an initial comprehensive evaluation is unrevealing. Although progress is being made, the sizeable portion of arrests that remain unexplained despite completion of a comprehensive evaluation highlights an ongoing need for further research and additional tools to help unravel the ongoing mysteries of these near fatal events.
确定不明原因心脏骤停的病因对于妥善处理幸存者及其家属至关重要。经体表心电图、超声心动图和冠状动脉造影检查后病因仍不明的心脏骤停未遂病例被视为不明原因。许多此类不明原因的心脏骤停被认为继发于隐匿形式的心脏离子通道病和潜在或隐匿的心肌病。这种认识促使人们评估一系列额外检查的诊断作用，包括先进的影像学检查、基因检测以及激发试验，如钠通道阻滞试验和运动平板试验。尽管有证据表明通过系统使用这些检查可提高诊断率，但临床指南尚未认可在诊断特发性室颤之前必须进行的正式检查流程，这导致得出该诊断的阈值存在显著差异。对于这些患者是否需要进行有创电生理检查仍存在争议，不过，对于需要心内电图进行诊断确认的心律失常罪犯的识别表明，在初始全面评估未发现异常时，有创电生理检查可能发挥作用。尽管取得了进展，但尽管完成了全面评估仍有相当一部分心脏骤停原因不明，这凸显了持续开展进一步研究和开发更多工具的必要性，以帮助揭开这些近乎致命事件的谜团。
