Predictive value of ventricular arrhythmias in resuscitated out-of-hospital cardiac arrest victims

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Abstract
Twenty-four hour ambulatory electrocardiograms recorded in 103 survivors of out-of-hospital cardiac arrest were analyzed to find those characteristics of the ventricular premature complex (VPC) which provide the best combination of sensitivity, specificity, and predictive accuracy for subsequent mortality. VPC characteristics were grouped as: (1) frequent (≥25 h−1), (2) bigeminal, (3) multiform, (4) early coupled, (5) pairing, (6) repetitive ≥2, (7) repetitive ≥3, (8) repetitive ≥6, (9) the combination of frequent and repetitive, or (10) complex defined as any multiform, early, bigeminal or repetitive VPC. In an average follow-up period of 43 months, 42 deaths occurred, 17 of which were classified as sudden. Each characteristic was a significant predictor for all causes of subsequent death except early coupled VPCs and repetitive VPCs > 6. None of the characteristics reached significance as predictors for sudden death. The number of repetitive VPCs when stratified to none, ≥2 and ≥3 successive VPCs correlated with mortality in an incremental fashion. The combination of frequent VPCs and repetitive VPCs provided the best combination of sensitivity, specificity and predictive accuracy for death from all causes within five years.