Prognostic value of transient conduction disturbance in out-of-hospital cardiac arrest.

Aim: A retrospective observational study to verify the impact of electrocardiograms (ECGs) following out-of-hospital cardiac arrest (OHCA) on mortality.

Methods: We retrospectively studied 101 OHCA patients who achieved a return of spontaneous circulation (ROSC) and survived for ≥3 h. Among them, 50 patients (66 ± 17 years; 22 male) were evaluated using 12-lead ECGs repeatedly and were included in the final analysis: immediately after ROSC (initial ECG) and after the initial evaluation in the emergency department (second ECG). Transient conduction disturbance (transient CD) was defined as a narrowing in QRS duration from the initial to second ECG of ≥18 ms. Multivariate Cox regression analyses were carried out to predict 90-day mortality following OHCA.

Results: Among 50 OHCA patients, 30 patients survived for 90 days. Thirty patients had initial ventricular fibrillation rhythm. Median emergency medical services response time and low-flow duration were 8 and 21 min, respectively. Multivariate analysis showed that the transient CD and low-flow duration were significant predictors of all-cause mortality (hazard ratio 16.55, 1.06;  = 0.001, 0.022, respectively).

Conclusion: Transient CD is a powerful predictor of 90-day mortality in patients who survived 3 h after ROSC from OHCA.