Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 81(11), 1007–1017. https://doi.org/10.1016/j.jacc.2023.01.041 Dr. Gherardo Finocchiaro et al.
Points
- Sudden arrhythmic death syndrome and myocardial diseases are the most common conditions diagnosed at autopsy in adolescent victims of sudden cardiac death (SCD).
- Arrhythmogenic cardiomyopathy, coronary artery anomalies, and commotio cordis are more common in young athletes than sedentary individuals, making them a high-risk group for SCD.
- Asthma, epilepsy, and obesity are the three main comorbidities associated with SCD in adolescents.
- The study highlights the need for appropriate screening and management of underlying cardiovascular conditions in young athletes to prevent SCD.
- By improving our understanding of the etiologies of SCD in adolescents, we can develop strategies to prevent and manage this devastating condition in this vulnerable population.
Summary
Sudden cardiac death (SCD) is a devastating event that often occurs in adolescents, but the causes and precipitating factors of SCD in this population are poorly understood. A recent study aimed to investigate the etiologies of SCD and their association with physical activity in a large cohort of adolescents. The study evaluated 7,675 cases of SCD that were referred to a national cardiac pathology center between 1994 and June 2022. Of these cases, 756 (10%) were adolescents who underwent a detailed autopsy evaluation by expert cardiac pathologists, and clinical information was obtained from referring coroners.
The most common autopsy finding in the adolescent SCD cases was a structurally normal heart, indicative of sudden arrhythmic death syndrome, found in 63% of cases. Myocardial diseases were detected in 22% of cases, including arrhythmogenic cardiomyopathy (5%), hypertrophic cardiomyopathy (4%), idiopathic left ventricular hypertrophy (4%), and myocarditis (4%). Coronary artery anomalies were identified in 2% of cases.
The study found that arrhythmogenic cardiomyopathy, coronary artery anomalies, and commotio cordis were more common in young athletes (17%) compared to sedentary individuals. Arrhythmogenic cardiomyopathy was diagnosed in 8% of athletes compared with 4% of nonathletes (P = 0.05), while 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 study also identified the three main comorbidities associated with SCD in adolescents as asthma (8%), epilepsy (6%), and obesity (5%).
These findings have important implications for preventing and managing SCD in adolescents, particularly in athletes who may be at increased risk due to certain cardiovascular conditions. The study highlights the need for appropriate screening and management of underlying cardiovascular conditions in young athletes and the importance of identifying comorbidities associated with SCD. By improving our understanding of the etiologies of SCD in adolescents, we can develop strategies to prevent and manage this devastating condition in this vulnerable population.
Link to the article: https://www.jacc.org/doi/10.1016/j.jacc.2023.01.041
References Finocchiaro, G., Radaelli, D., D’Errico, S., Papadakis, M., Behr, E. R., Sharma, S., Westaby, J., & Sheppard, M. N. (2023). Sudden cardiac death among adolescents in the united kingdom. Journal of the American College of Cardiology, 81(11), 1007–1017. https://doi.org/10.1016/j.jacc.2023.01.041
