EPIDEMIOLOGY

Sudden arrhythmic death syndrome: a national survey of sudden unexplained cardiac death

E R Behr¹, A Casey², M Sheppard², M Wright², T J Bowker², M J Davies^1,*, W J McKenna³, D A Wood²

¹ Cardiological Sciences, St George’s University of London, London, UK
² Clinical Epidemiology and Pathology, National Heart & Lung Institute at Royal Brompton & Harefield Campus, Imperial College, University of London, London, UK
³ The Heart Hospital, University College Hospital, London, UK

Correspondence to:
Professor D A Wood
Clinical Epidemiology and Pathology, National Heart & Lung Institute at Royal Brompton & Harefield Campus, Imperial College, University of London, London W6 8RF, UK;d.wood{at}imperial.ac.uk

Objective: To describe the characteristics of sudden arrhythmic death syndrome (SADS) and compare its incidence with official national mortality statistics for unascertained deaths.

Design and setting: Sudden unexplained deaths were prospectively surveyed through 117 coroners’ jurisdictions in England. Consecutive cases meeting the following criteria were included: white Caucasian, aged 4–64 years, no history of cardiac disease, last seen alive within 12 h of death, normal coroner’s autopsy, cardiac pathologist’s confirmation of a normal heart and negative toxicology.

Main outcome measures: The estimated mortality from SADS was calculated and the official mortality statistics for unascertained causes of deaths in 4–64-year-olds was identified for the same time period.

Results: 115 coroner’s cases were reported and 56 (49%) SADS victims were identified: mean age 32 years, range 7–64 years and 35 (63%) male. 7 of 39 cases (18%) had a family history of other premature sudden deaths (<45). The estimated mortality from SADS was 0.16/100 000 per annum (95% CI 0.12 to 0.21), compared with an official mortality of 0.10/100 000 per annum for International Classification of Diseases 798.1 (sudden death, cause unknown—instantaneous death) or 1.34/100 000 per annum for unascertained causes of death.

Conclusions: Deaths from SADS occur predominantly in young males. When compared with official mortality, the incidence of SADS may be up to eight times higher than estimated: more than 500 potential SADS cases per annum in England. Families with SADS carry genetic cardiac disease, placing them at risk of further sudden deaths. SADS should therefore be a certifiable cause of death prompting specialised cardiological evaluation of families.

Abbreviations: ICD, International Classification of Diseases; LREC, local research ethics committee; ONS, Office of National Statistics; SADS, sudden arrhythmic death syndrome

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