[Patients resuscitated from cardiopulmonary arrest: clinical and electrophysiologic study]

Clinical and electrophysiologic studies (EPS) were carried out in 12 patients who were resuscitated from cardiopulmonary arrest (CPA). They were 8 males and 4 females, ranging from 33 to 73 years of age with a mean of 55 years. Underlying diseases included old myocardial infarction (OMI) with aneurysm (An) in 6 patients, variant angina, arrhythmogenic right ventricular dysplasia, Romano-Ward syndrome, complete atrioventricular block in one each, and diseases of unknown etiology in 2. Ergonovine-provocative coronary angiography (CAG) was performed in 3 patients, and EPS including ventricular tachycardia study was performed in 7. Coronary artery spasm was induced in one patient during CAG; sustained monomorphic ventricular tachycardia in 4 patients; and repetitive ventricular response in 2 of 7 patients examined by EPS. The causes of cardiopulmonary arrest were clearly demonstrated by the above-described examinations in 3 cases of clinically unidentified etiology. Drug therapy was performed in 6 patients during EPS (1.7 drugs/case), which was effective in one, ineffective in 3, and undetermined in 2. Of 2 patients whose surgical treatment was unsuccessful, atrial pacing with propranolol administration was used in a patient with Romano-Ward syndrome. The remaining patients were followed up medically. Cardiopulmonary arrest recurred in 3 patients and resuscitation was not successful in any of them; one with OMI and the other 2 with idiopathic ventricular fibrillation who refused EPS and died suddenly 10 months and 12 months after their initial resuscitation. Cardiac arrest did not recur in any of those who underwent complete examinations and were treated with medications, however, it recurred in 3 of 5 patients without complete medications. As a whole, cardiopulmonary arrest recurred in 3 of 12 patients (25%) within one year after the onset of symptoms. To reduce the possibility of the recurrence of arrest and improve prognosis in patients with previous successful cardiac resuscitation, intensive examinations for the causes, therapy including EPS and ergonovine CAG, full medications and surgical treatment may be helpful.