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European Heart Journal Sep 2021The aim of this study was to examine the effect of dapagliflozin on the incidence of ventricular arrhythmias and sudden death in patients with heart failure and reduced... (Randomized Controlled Trial)
Randomized Controlled Trial
AIMS
The aim of this study was to examine the effect of dapagliflozin on the incidence of ventricular arrhythmias and sudden death in patients with heart failure and reduced ejection fraction (HFrEF).
METHODS AND RESULTS
In a post hoc analysis of DAPA-HF, we examined serious adverse event reports related to ventricular arrhythmias or cardiac arrest, in addition to adjudicated sudden death. The effect of dapagliflozin, compared with placebo, on the composite of the first occurrence of any serious ventricular arrhythmia, resuscitated cardiac arrest, or sudden death was examined using Cox proportional hazards models. A serious ventricular arrhythmia was reported in 115 (2.4%) of the 4744 patients in DAPA-HF (ventricular fibrillation in 15 patients, ventricular tachycardia in 86, 'other' ventricular arrhythmia/tachyarrhythmia in 12, and torsade de pointes in 2 patients). A total of 206 (41%) of the 500 cardiovascular deaths occurred suddenly. Eight patients survived resuscitation from cardiac arrest. Independent predictors of the composite outcome (first occurrence of any serious ventricular arrhythmia, resuscitated cardiac arrest or sudden death), ranked by chi-square value, were log-transformed N-terminal pro-B-type natriuretic peptide, history of ventricular arrhythmia, left ventricular ejection fraction, systolic blood pressure, history of myocardial infarction, male sex, body mass index, serum sodium concentration, non-white race, treatment with dapagliflozin, and cardiac resynchronization therapy. Of participants assigned to dapagliflozin, 140/2373 patients (5.9%) experienced the composite outcome compared with 175/2371 patients (7.4%) in the placebo group [hazard ratio 0.79 (95% confidence interval 0.63-0.99), P = 0.037], and the effect was consistent across each of the components of the composite outcome.
CONCLUSIONS
Dapagliflozin reduced the risk of any serious ventricular arrhythmia, cardiac arrest, or sudden death when added to conventional therapy in patients with HFrEF.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov unique identifier: NCT03036124 (DAPA-HF).
Topics: Arrhythmias, Cardiac; Benzhydryl Compounds; Death, Sudden; Death, Sudden, Cardiac; Glucosides; Heart Arrest; Heart Failure; Humans; Male; Stroke Volume; Ventricular Function, Left
PubMed: 34448003
DOI: 10.1093/eurheartj/ehab560 -
Fa Yi Xue Za Zhi Jun 2022In recent years, the increase in the number of cases of postural asphyxia has gradually attracted the attention and discussion of forensic scientists domestically and... (Review)
Review
In recent years, the increase in the number of cases of postural asphyxia has gradually attracted the attention and discussion of forensic scientists domestically and internationally, but a systematic, comprehensive and recognized expert consensus and identification standard has not been established at home and abroad. This paper reviews the case characteristics, occurrence, mechanism of death, and identification criteria of postural asphyxia, to provide reference for future research.
Topics: Asphyxia; Forensic Medicine; Forensic Pathology; Humans
PubMed: 36221835
DOI: 10.12116/j.issn.1004-5619.2020.400813 -
European Heart Journal Mar 2023This study aimed to report the long-term findings of the Italian programme of cardiovascular preparticipation screening (PPS) in young, competitive athletes.
AIMS
This study aimed to report the long-term findings of the Italian programme of cardiovascular preparticipation screening (PPS) in young, competitive athletes.
METHODS AND RESULTS
The study assessed the diagnostic yield for diseases at risk of sudden cardiac death (SCD), the costs of serial evaluations, and the long-term outcomes of PPS in a large population of Italian children (age range, 7-18 years). The PPS was repeated annually and included medical history, physical examination, resting electrocardiogram, and stress testing; additional tests were reserved for athletes with abnormal findings. Over an 11-year study period, 22 324 consecutive children [62% males; mean age, 12 (interquartile range, 10-14) years at first screening] underwent a total of 65 397 annual evaluations (median 2.9/child). Cardiovascular diseases at risk of SCD were identified in 69 children (0.3%) and included congenital heart diseases (n = 17), channelopathies (n = 14), cardiomyopathies (n = 15), non-ischaemic left ventricular scar with ventricular arrhythmias (n = 18), and others (n = 5). At-risk cardiovascular diseases were identified over the entire age range and more frequently in children ≥12 years old (n = 63, 91%) and on repeat evaluation (n = 44, 64%). The estimated cost per diagnosis was 73 312€. During a follow-up of 7.5 ± 3.7 years, one child with normal PPS findings experienced an episode of resuscitated cardiac arrest during sports activity (event rate of 0.6/100.000 athletes/year).
CONCLUSION
The PPS programme led to the identification of cardiovascular diseases at risk of SCD over the whole study age range of children and more often on repeat evaluations. Among screened children, the incidence of sport-related cardiac arrest during long-term follow-up was low.
Topics: Male; Child; Humans; Adolescent; Female; Death, Sudden, Cardiac; Sports; Electrocardiography; Athletes; Heart Arrest; Mass Screening
PubMed: 36760222
DOI: 10.1093/eurheartj/ehad017 -
Anesthesiology Jun 2024The near-death experience has been reported since antiquity and is often characterized by the perception of light, interactions with other entities, and life recall.... (Review)
Review
The near-death experience has been reported since antiquity and is often characterized by the perception of light, interactions with other entities, and life recall. Near-death experiences can occur in a variety of situations, but they have been studied systematically after in-hospital cardiac arrest, with an incidence of 10 to 20%. Long attributed to metaphysical or supernatural causes, there have been recent advances in understanding the neurophysiologic basis of this unique category of conscious experience. This article reviews the epidemiology and neurobiology of near-death experiences, with a focus on clinical and laboratory evidence for a surge of neurophysiologic gamma oscillations and cortical connectivity after cardiac and respiratory arrest.
Topics: Humans; Consciousness; Brain; Death; Heart Arrest; Brain Death
PubMed: 38603803
DOI: 10.1097/ALN.0000000000004970 -
Ugeskrift For Laeger Jun 2022Sudden and unexpected death is defined as sudden death without any obvious cause and where the person was seen in habitual conditions within the last 24 hours before... (Review)
Review
Sudden and unexpected death is defined as sudden death without any obvious cause and where the person was seen in habitual conditions within the last 24 hours before death. Persons with epilepsy have a 34-fold increased risk of dying suddenly and unexpectedly compared with the background population. In persons with epilepsy these deaths are referred to as sudden unexpected death in epilepsy (SUDEP). This review finds that the risk is highest in younger adults, and SUDEP is the second leading cause of death in persons with epilepsy aged 1-49 years. Good seizure control is important in the prevention of SUDEP.
Topics: Adult; Death, Sudden; Epilepsy; Humans; Referral and Consultation; Sudden Unexpected Death in Epilepsy
PubMed: 35786225
DOI: No ID Found -
Current Opinion in Neurology Apr 2021The serotonergic system is implicated in multiple aspects of epilepsy, including seizure susceptibility, sudden unexpected death in epilepsy (SUDEP), and comorbid... (Review)
Review
PURPOSE OF REVIEW
The serotonergic system is implicated in multiple aspects of epilepsy, including seizure susceptibility, sudden unexpected death in epilepsy (SUDEP), and comorbid depression. Despite the complexity of serotonin's effects on various neuronal networks, ongoing research provides considerable insight into the role of serotonin in human epilepsy. This review explores the potential roles of serotonergic therapies to improve clinical outcomes in epilepsy.
RECENT FINDINGS
In recent decades, research has markedly increased our knowledge of the diverse effects of serotonin on brain function. Animal models of epilepsy have identified the influence of serotonin on seizure threshold in specific brain regions, serotoninergic augmentation's protective effects on terminal apnea and mortality in SUDEP, and mechanisms underlying behavioral improvement in some models of comorbid depression. Human clinical studies are largely consistent with animal data but the translation into definitive treatment decisions has moved less rapidly.
SUMMARY
Evidence for serotonergic therapy is promising for improvement in seizure control and prevention of SUDEP. For some epilepsies, such as Dravet syndrome, basic research on serotonin receptor agonists has translated into a positive clinical trial for fenfluramine. The cumulative results of safety and efficacy studies support the routine use of SSRIs for comorbid depression in epilepsy.
Topics: Animals; Brain; Death, Sudden; Epilepsy; Humans; Seizures; Sudden Unexpected Death in Epilepsy
PubMed: 33664206
DOI: 10.1097/WCO.0000000000000901 -
Experimental and Clinical... Apr 2022The wait list for organ transplant exceeds the rate of organ donation, especially in children. The solid-organ transplant rate has remained stable over time, despite... (Review)
Review
The wait list for organ transplant exceeds the rate of organ donation, especially in children. The solid-organ transplant rate has remained stable over time, despite increased demand. Although donation after cardiac death has helped to expand the donor organ pool for the adult population, this option remains scarce for children in need of transplant. Because long-term graft survival is more important in the pediatric group than in adults, we should reconsider the common notion that donation after cardiac death is inferior to donation after brain death. Herein, we review the literature to extract and analyze data regarding donation after cardiac death for solid-organ transplant in children.
Topics: Adult; Brain Death; Child; Death; Humans; Tissue Donors; Tissue and Organ Procurement; Treatment Outcome
PubMed: 35570595
DOI: 10.6002/ect.PediatricSymp2022.L9 -
Experimental and Clinical... Apr 2024The definition of death remains unresolved. To define death, one has to define the characteristics of a living person and to confirm whether an individual with brain...
The definition of death remains unresolved. To define death, one has to define the characteristics of a living person and to confirm whether an individual with brain death fulfils any of these characteristics. Although the concept of irreversible cessation of brain function is clear, controversy remains on the treatment of individuals with brain death and beating hearts. An individual with brain death but a beating heart is not breathing on his own and is dependent on medications and machines to maintain respiration, heartbeat, and blood pressure. Muslim scholars remain divided over the issue of whether death also means irreversible cessation of brain function. Questions remain on when it is permissible to remove vital organs for organ transplant. Groups have advocated for uniformity in law and medical practice on the definition of brain death.
Topics: Humans; Attitude to Death; Brain Death; Death; History, 20th Century; History, 21st Century; Islam; Organ Transplantation; Religion and Medicine; Terminology as Topic; Tissue and Organ Procurement
PubMed: 38775693
DOI: 10.6002/ect.BDCDSymp.L8 -
International Journal of Molecular... Mar 2023Sudden cardiac death (SCD) and arrhythmias represent a global public health problem, accounting for 15-20% of all deaths [...].
Sudden cardiac death (SCD) and arrhythmias represent a global public health problem, accounting for 15-20% of all deaths [...].
Topics: Humans; Risk Factors; Arrhythmias, Cardiac; Death, Sudden, Cardiac; Ion Channels
PubMed: 36902430
DOI: 10.3390/ijms24054999 -
Journal of the American College of... May 2022
Topics: Cardiopulmonary Resuscitation; Death, Sudden; Death, Sudden, Cardiac; Emergency Medical Services; Hospitals; Humans; Out-of-Hospital Cardiac Arrest
PubMed: 35512863
DOI: 10.1016/j.jacc.2022.03.004