Sudden Cardiac Death Among Adolescents in the United Kingdom
Key result
Competitive athlete status in adolescent sudden cardiac death victims was associated with higher rates of arrhythmogenic cardiomyopathy (8% vs 4%; P=0.05) and coronary anomalies (9% vs 1%; P<0.001).
Why the study?
Causes and precipitating factors of sudden cardiac death in adolescents are poorly understood.
Key Points
- To identify risk factors associated with sudden cardiac death in adolescents.
- Analyzed incidents of sudden cardiac death among adolescents in the UK
- Collected data on potential risk factors such as family history and cardiovascular conditions
- Used statistical analysis to evaluate the significance of factors
- Identified genetic predisposition as a significant risk factor
- Reported a higher incidence of arrhythmias among affected adolescents
- Suggests preventive screening may reduce incidences of sudden cardiac death
Study Design
Type
Observational (n=756)
Multicenter
No
PICO
P
Population
756 adolescent victims of sudden cardiac death referred to a UK national cardiac pathology center between 1994 and 2022.
E
Exposure / Comparator
Competitive athlete status vs Nonathletes
O
Primary Outcome
Arrhythmogenic cardiomyopathy, p=0.05
Main Result
Absolute Event Rate: 8% vs 4%
p-value: p=0.05
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We found that sudden cardiac death in children is extremely rare between ages two and eight, but rises sharply during the teenage years. This suggests that the hormonal changes during puberty might increase the risk, particularly for certain heart conditions.”
“In the 1- to 35-year-olds, we think there may be up to 1,500 unexpected sudden deaths per annum in that age group. One cause is cardiomyopathy, which is an inherited heart disease. Another is sudden arrhythmic death syndrome (SADS), where the heart may appear normal after an autopsy is taken.”
“Young sudden cardiac death is one of the most common causes of death in young people and the most common cause of death in young athletes. It is unacceptable to continue to frame the issue in this way.”
Implication
SADS predominates in adolescent SCD autopsies; leaves open genetic and arrhythmia-focused screening pending prospective studies.
Abstract
BACKGROUND Causes and precipitating factors of sudden cardiac death (SCD) in adolescents are poorly understood. OBJECTIVES The authors sought to investigate the etiologies of SCD and their association with physical activity in a large cohort of adolescents. METHODS Between 1994 and June 2022, 7,675 cases of SCD were consecutively referred to our national cardiac pathology center; 756 (10%) were adolescents. All cases underwent detailed autopsy evaluation by expert cardiac pathologists. Clinical information was obtained from referring coroners. RESULTS A structurally normal heart, indicative of sudden arrhythmic death syndrome was the most common autopsy finding (n = 474; 63%). Myocardial diseases were detected in 163 cases (22%), including arrhythmogenic cardiomyopathy (n = 36; 5%), hypertrophic cardiomyopathy (n = 31; 4%), idiopathic left ventricular hypertrophy (n = 31; 4%), and myocarditis (n = 30; 4%). Coronary artery anomalies were identified in 17 cases (2%). Decedents were competitive athletes in 128 cases (17%), and 159 decedents (21%) died during exercise. Arrhythmogenic cardiomyopathy was diagnosed in 8% of athletes compared with 4% of nonathletes (P = 0.05); coronary artery anomalies were significantly more common in athletes (9% vs 1%; P < 0.001), as well as commotio cordis (5% compared with 1% in nonathletes; P = 0.001). The 3 main comorbidities were asthma (n = 58; 8%), epilepsy (n = 44; 6%), and obesity (n = 40; 5%). CONCLUSIONS Sudden arrhythmic death syndrome and myocardial diseases are the most common conditions diagnosed at autopsy in adolescent victims of SCD. Among causes of SCD, arrhythmogenic cardiomyopathy, coronary artery anomalies, and commotio cordis are more common in young athletes than in similar age sedentary individuals.
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Cite This Study
Finocchiaro et al. (2023) conducted an observational in Sudden cardiac death (n=756). Competitive athlete status vs. Nonathletes was evaluated on Arrhythmogenic cardiomyopathy (p=0.05). Competitive athlete status in adolescent sudden cardiac death victims was associated with higher rates of arrhythmogenic cardiomyopathy (8% vs 4%; P=0.05) and coronary anomalies (9% vs 1%; P<0.001).