Sudden Arrhythmic Death Syndrome in the Young: Risk Factors are Identifiable Prior to Sudden Cardiac Arrest.

Abstract

Sudden arrhythmic death syndrome (SADS) is one of the most common post-mortem diagnoses in the young suffering sudden cardiac death (SCD). Phenotypic characterization may facilitate prevention. The aim of the present study was to characterize phenotypes of SADS in the young including comparison with up to 10 controls per case. All SCD cases among 0-35 years old in Sweden during 2000-2010, have previously been included in the SUDden cardiac Death in the Young cohort (SUDDY), including five controls. Medical records, ECGs, death certificates, autopsy reports and national register data were analyzed. SADS accounted for 22% (149/670) of all SCDs in 1-35 years old during the study period. Most victims were male (n= 97,65%) and median age at death was 23. Pathological ECGs were found in 18%, with preexcitation being the most prevalent finding. Previous healthcare visits within 180 days prior to death was significantly more common in SADS victims (34 vs 23%; p=0.011). Among SADS victims, health care contacts within a year prior to death were significantly more common for syncope (4 vs 0.2%; p=0.007) and seizure/convulsion (4% vs 0.4%; p=0.006). A family history of cardiac disease/SCD was present in 13%. Psychiatric diagnoses and psychotropic use were found in 17% and 11%, respectively. Infection (9%) and nausea/vomiting (7%) were the most reported symptoms within 24 hours of death. We conclude that a high prevalence of prior healthcare visits, symptoms and ECG abnormalities offers an opportunity to identify subjects at risk of SADS. Psychiatric disease and the use of psychotropics might be risk factors for SADS.