Sudden unexpected death during ambulatory electrocardiographic monitoring. The Framingham Study

This report documents the clinical and electrocardiographic events of sudden unexpected death in a 52-year-old man without known heart disease during ambulatory electrocardiographic monitoring. This death occurred two and a half hours after detailed noninvasive testing, including treadmill exercise, that was unrevealing. The sequence of S-T change suggesting epicardial injury, multiform ventricular premature depolarizations, and frequent and early cycle ventricular premature depolarizations followed by ventricular tachycardia-flutter-fibrillation precipitated by an early cycle ventricular premature depolarization were documented. The delay in cardiopulmonary resuscitation in this witnessed cardiac arrest punctuates the need for widespread dissemination of the skills of cardiopulmonary resuscitation.