A Prospective Study of Sudden Cardiac Death among Children and Young Adults

BACKGROUND

Sudden cardiac death among children and young adults is a devastating event. We performed a prospective, population-based, clinical and genetic study of sudden cardiac death among children and young adults.

METHODS

We prospectively collected clinical, demographic, and autopsy information on all cases of sudden cardiac death among children and young adults 1 to 35 years of age in Australia and New Zealand from 2010 through 2012. In cases that had no cause identified after a comprehensive autopsy that included toxicologic and histologic studies (unexplained sudden cardiac death), at least 59 cardiac genes were analyzed for a clinically relevant cardiac gene mutation.

RESULTS

A total of 490 cases of sudden cardiac death were identified. The annual incidence was 1.3 cases per 100,000 persons 1 to 35 years of age; 72% of the cases involved boys or young men. Persons 31 to 35 years of age had the highest incidence of sudden cardiac death (3.2 cases per 100,000 persons per year), and persons 16 to 20 years of age had the highest incidence of unexplained sudden cardiac death (0.8 cases per 100,000 persons per year). The most common explained causes of sudden cardiac death were coronary artery disease (24% of cases) and inherited cardiomyopathies (16% of cases). Unexplained sudden cardiac death (40% of cases) was the predominant finding among persons in all age groups, except for those 31 to 35 years of age, for whom coronary artery disease was the most common finding. Younger age and death at night were independently associated with unexplained sudden cardiac death as compared with explained sudden cardiac death. A clinically relevant cardiac gene mutation was identified in 31 of 113 cases (27%) of unexplained sudden cardiac death in which genetic testing was performed. During follow-up, a clinical diagnosis of an inherited cardiovascular disease was identified in 13% of the families in which an unexplained sudden cardiac death occurred.

CONCLUSIONS

The addition of genetic testing to autopsy investigation substantially increased the identification of a possible cause of sudden cardiac death among children and young adults. (Funded by the National Health and Medical Research Council of Australia and others.)

Supported by a project grant (#632575) from the National Health and Medical Research Council (NHMRC), a grant from the Zig Inge Foundation (2009–2011), and research grants from the RT Hall Foundation and the Thrasher Research Fund. Dr. Ingles is a recipient of an Early Career Fellowship (#1036756) from the NHMRC and the National Heart Foundation of Australia. Dr. Semsarian is the recipient of a Practitioner Fellowship (#1059156) from the NHMRC. Dr. Skinner and the Cardiac Inherited Disease Group are partly funded by Cure Kids.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

Dr. Weintraub reports receiving fees for serving on an advisory board from Actelion; and Dr. Davis, receiving grant support from Medtronic and St. Jude Medical. No other potential conflict of interest relevant to this article was reported.

We thank all the families across Australia and New Zealand who participated in this study during such a tragic time in their lives, all for the betterment of future generations, and the many clinicians and scientists of the TRAGADY group (Trans-Tasman Response against Sudden Death in the Young), the Cardiac Inherited Disease Group, the Luke Foundation (founded in memory of Luke Pawlak), and the Australian Genetic Heart Disease Registry for supporting and educating the families in which a sudden cardiac death occurred.

SOURCE INFORMATION

From the Agnes Ginges Center for Molecular Cardiology, Centenary Institute, University of Sydney (R.D.B., J.I., L.Y., L.L., C.S.), Sydney Medical School, University of Sydney (R.D.B., J.I., J.D., R.P., C.S.), Department of Forensic Medicine, NSW Health Pathology (J.D.), and Department of Cardiology, Royal Prince Alfred Hospital (J.I., L.Y., R.P., C.S.), Sydney, the Department of Cardiology, Royal Children’s Hospital, Murdoch Children’s Research Institute and University of Melbourne (R.G.W., A.M.D., V.C., D.S.), Departments of Pediatrics (A.M.D.) and Pathology (P.J.), University of Melbourne, Genetic Medicine, Royal Melbourne Hospital (T.T., P.J., J.V., I.W.), Department of Medicine, Royal Melbourne Hospital, University of Melbourne (J.V., I.W.), and Victorian Institute of Forensic Medicine (M.L., N.M.), Melbourne, VIC, Forensic and Scientific Services, Archerfield, QL (J.W., C.N.), University of Queensland (J.W., C.N.), and Royal Brisbane and Women’s Hospital (J.A., J.M.), Brisbane, QL, Department of Forensic Pathology, PathWest, Fremantle, WA (J.W.), ACT Pathology, Canberra Hospital, Canberra, ACT (L.H.), Royal Hobart Hospital, University of Tasmania, Hobart, TAS (C.L.), and the Attorney General’s Department, University of Adelaide, Adelaide, SA (N.L.) — all in Australia; and Green Lane Pediatric and Congenital Cardiac Services, Starship Children’s Hospital (J.C., J.R.S.), LabPLUS, Auckland City Hospital (D.L.), and the Department of Child Health, University of Auckland (J.R.S.), Auckland, New Zealand.

Address reprint requests to Dr. Semsarian at the Agnes Ginges Center for Molecular Cardiology, Centenary Institute, University of Sydney, Locked Bag 6, Newtown NSW 2042, Australia, or at .

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Autor / Fonte:Richard D. Bagnall, Ph.D., Robert G. Weintraub, M.B., B.S., Jodie Ingles, Grad.Dip.Gen.Couns., Ph.D., M.P.H., more. N Engl J Med 2016; 374:2441-2452June 23, 2016DOI: 10.1056/NEJMoa1510687
Link: http://www.nejm.org/doi/full/10.1056/NEJMoa1510687