Life After Sudden Death

Drew Logan doesn't remember being dead.

He does, however, remember the day he died. Mostly, it was just an ordinary Monday.

It was Oct. 4, 2004, and death was nowhere near Drew's mind. The 30-year-old fitness coach had spent the day training clients at the gym near his home in Nashville, Tenn. An avid athlete since the age of 5, he'd parlayed his athletic skills and passion for fitness into a successful career as a personal trainer, building a clientele of country music industry professionals and NFL and NBA athletes.

He was in phenomenal shape, with only 5 percent body fat. But later that cool Monday evening, he would find himself face-down on the hallway floor — dead.

In fact, Drew would die not just once, but three times in the same night. The culprit each time: sudden cardiac arrest, a sudden electrical chaos in the heart that stops a heartbeat cold and brings death in mere minutes.

Unlike a heart attack, which occurs when a blocked artery disrupts the flow of oxygen-rich blood to the heart, causing heart muscle to die, sudden cardiac arrest typically arrives with little to no warning. The electrical havoc disrupts the ventricles, which then quiver uselessly and can no longer pump blood to the body.

It's an enigmatic and lethal condition that doctors and scientists have long struggled to understand and predict. But now, more than a decade into the most comprehensive community study of sudden cardiac arrest ever undertaken, exciting new clues are emerging that could pave the path for a personalized medicine approach to sudden cardiac arrest — and a way to predict it before it happens.

That's critical because each year, 300,000 Americans have a sudden cardiac arrest — but only a scant 5 percent survive. For the rest, help either arrives too late, or not at all, as many victims are alone at the time.

Drew was one of the lucky ones.

Only a last-minute change of plans kept Drew from being alone on that fateful October night eight years ago. He had been planning a quiet evening at home. But on his way home from work, his girlfriend called, inviting him over for dinner to celebrate her new job. Drew turned the car around and headed to her house.

"That was the deciding factor," he says. "Had I gone home, I would have never survived."

It was after dinner when his ordinary day turned deadly. He and his girlfriend were at the computer making vacation plans, when suddenly, Drew began seeing tunnel vision and felt excruciating pain in his head. He slumped to the floor.

Just as suddenly, though, he woke up, appearing to be OK. His frightened girlfriend thought he'd had a seizure and insisted on taking him to the hospital. He agreed, then walked to the bathroom to splash some water on his face. On his way out of the bathroom, though, the second sudden cardiac arrest hit.

In an instant, he fell face-down on the hallway floor. Unable to move, he was scared, but strangely calm. His only thought: "I'm dying."

He was right. By the time paramedics arrived and restarted his heart, Drew had been dead for six dangerously long minutes. Later that night, in intensive care, his heart stopped a third time, and doctors again jolted him back to life.

Doctors couldn't find any other case where someone had survived three sudden cardiac arrests. They also couldn't find answers for why the heart of a healthy, athletic young man would suddenly stop — three times in one night.

"There's nothing wrong with you," they told him. "Your heart is completely normal."

Twenty years ago, the sudden cardiac arrest of another healthy young person forever changed the life of Sumeet S. Chugh, MD.

At the time, he was a young medical resident at a Minneapolis emergency room when a 19-year-old woman was rushed in. She had collapsed while dancing. Like Drew, the woman's heart was healthy. Unlike Drew, she died.

Dr. Chugh was part of the team that tried to revive her, and the experience inspired him to become a cardiologist — and dedicate his career to finding how to better predict this swift and stealthy killer.

"If we wait until someone has a sudden cardiac arrest, it is usually too late," says Dr. Chugh, associate director of the Heart Institute and director of Clinical Cardiac Electrophysiology at Cedars-Sinai Medical Center. "We absolutely must get a better handle on predicting it so we can intervene before it happens."

That intervention usually involves implanting a defibrillator, a battery-powered device that can detect abnormal electrical activity and shock the heart back into rhythm if needed. Defibrillators work; the problem is figuring out who needs one.

Patients with healthy hearts, like Drew, account for about 5 percent of sudden cardiac arrests. Most have coronary artery disease or some heart abnormality. Still, prediction methods for cardiac arrest are woefully inadequate. Currently, only one out of every 20 implanted defibrillators is called upon for a lifesaving shock during the course of a year. In other words, most are being given to patients who are unlikely to benefit from them.

"We really have no way of predicting the vast majority of sudden cardiac arrests," says Dr. Chugh, who holds the Pauline and Harold Price Chair in Cardiac Electrophysiology Research. "We're almost completely at sea."

His determination to change that led him to initiate a novel and extremely ambitious endeavor 11 years ago: the Oregon Sudden Unexpected Death Study (Ore-SUDS).

The far-reaching epidemiological study, which he continues to lead, involves 16 hospitals, a network of medical examiners and all fire and ambulance crews in the Portland area. With their help, he and his vast team have been doggedly tracking and analyzing every case of sudden cardiac arrest — more than 3,000 so far — that occurs among the region's 1 million residents.

Their persistence is paying off. Slowly but surely, the study is uncovering a trail of important clues that hold new promise in unlocking the mystery of this lethal and long-elusive condition.

Ore-SUDS already has demonstrated such risk factors as lower socioeconomic status, family history, and specific electrical abnormalities of the heart. Dr. Chugh's team also has presented preliminary findings linking free fatty acids (such as trans fats) and elevated estrogen levels in men, to the disorder.

Then, last year, he and an international consortium of physician-scientists reported perhaps the most exciting finding yet: a novel genetic link to sudden cardiac arrest, the first one identified in the broader community. The link, a variation in the BAZ2B gene, appears to double an individual's risk of sudden cardiac arrest.

The groundbreaking discovery is an important step toward developing a "personalized medicine" approach to the condition — using genetics to predict, prevent, and possibly treat sudden cardiac arrest before it strikes its unsuspecting victims.

The consortium is now conducting a larger study to confirm the finding and identify other possible genetic "hot spots" linked to the condition. But Dr. Chugh suspects that, for most patients, the answer to the puzzle will involve a multitude of interrelated culprits, from genetic and clinical to behavioral, environmental and psychological factors, including stress.

His goal: to create a battery of screening tests and comprehensive "risk score" that can more reliably predict the condition. Uncovering more pathways to electrical chaos also will pave the way for new preventive treatments to emerge.

"Complex problems typically have complex solutions," Dr. Chugh says. He is clearly passionate about finding those solutions. "I can't imagine doing anything else. We have the chance to prevent so many deaths."

Given everything he's been through, it's not surprising that Drew named his dog "Lucky."

A shiny black Plott hound with gentle, doe-like brown eyes, Lucky insists on licking every visitor's face and burying his wet nose in nearly every outstretched hand.

But Lucky has another, more serious job besides man's best friend. A cardiac therapy dog, he's specially trained to alert Drew to increased stress and warning signs of heart trouble, such as high blood pressure. The dog has been Drew's constant companion for the past six years.

"We're never apart!" says Drew, laughing. "Only one time, for a vacation a few years ago. He's probably flown more than 150,000 miles with me."

For the past four years, Drew has been living full time in Manhattan Beach and now works as a personal trainer in the entertainment industry. At 38, he continues to weight train five days a week, run half-marathons, and work as a fitness model.

He's in perfect health, and Dr. Chugh is now his doctor. He's never had another sudden cardiac arrest. Even Lucky has only had to alert him one time, when his blood pressure was rising while in traffic on the 405 freeway.

Meanwhile, an implanted defibrillator sits just under the skin of his chest, ready to jolt his heart into rhythm if needed. It has never had to fire. But he gets asked about it a lot.

"At first I didn't want anyone to see it," says Drew, who grew up in Lexington, Ky., and speaks with a slight Southern drawl. "Now I don't hide it. It's my opportunity to tell people what happened, to tell them about sudden cardiac arrest."

Sitting at his kitchen table on a warm August afternoon in Manhattan Beach — with Lucky relaxing on the floor next to him and his other dog, Brandy — Drew recounts how his experience with death changed him.

Although he has no memory of death itself, what he does remember clearly is that moment he knew for certain that he was dying.
"It's like you know when you're happy, or when you're sad, or when you're in love," he says. "You just know."

Although he quickly recovered with no physical damage, his experience took an emotional toll. Initially, he went through an intense depression, unable to get out of bed at times. When that January rolled around, though, he forced himself to answer the many calls for "New Year's resolution" training. Through helping others, his depression lifted. And he soon found himself with a renewed purpose.

He began incorporating heart health education into his training, and spreading the word wherever he went. He and several friends have raced in relay in triathlons, using the occasion to raise awareness of heart disease and sudden cardiac arrest. His next project: writing a book about fitness, nutrition, and heart health.

"I'm more inspired to truly live than I ever was before, and to inspire others to live a fuller and healthier life," he says. "I look at it as a second chance — no, a third and fourth chance — to make a difference."