Sudden cardiac death during anesthesia in non-cardiac surgery and its link to possible cardiac channelopathies: A case series

Cardiac arrest with induction of anesthesia in those who appear healthy with no apparent cardiovascular disease is rare and the autopsy is essential to identify any underlying cardiac pathology. A retrospective analysis of the database of sudden cardiac deaths referred to the CRY Centre, St. Georges University of London identified 7 cases in which death occurred during anesthesia. We found 3 cases with explained causes; peripartum cardiomyopathy, myocarditis and ischemic heart disease where the risk of sudden cardiac death in anesthesia is well known and helps anesthetists and surgeons explain the cardiac arrest. More importantly there were 4 cases with morphologically normal hearts with no apparent cardiovascular disease who developed bradycardia and cardiac arrest with the induction of anesthesia. This raises the possibility of cardiac ion channelopathies when nothing else is found at autopsy and there is no aesthetic cause. The negative autopsy has major implications for the families requiring detailed cardiovascular screening of the immediate family to prevent future sudden deaths. All surgical teams need to be aware of this and advise the families accordingly in these traumatic situations.