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Sudden death in childhood is rare. About 10% of paediatric deaths after the first year of life are sudden and population based studies put the individual age related risk at around 1:20 000 to 1:50 000 per year.1–4w1–3 About half of these deaths are related to a previously known abnormality, the most common being epilepsy, asthma, and cardiovascular abnormalities. Another third are attributed to an abnormality discovered at necropsy, usually either an infection or a cardiovascular abnormality. At least one sudden death in six remains unexplained, but this is almost certainly an underestimate as some deaths attributed by the coroner's pathologist to epilepsy or respiratory infection are probably more accurately described as being unexplained by findings at necropsy.4w4
MECHANISMS OF SUDDEN DEATH
Although all deaths result in asystole, not all sudden deaths are caused by arrhythmias. The precise mechanism of sudden death depends upon the cause. One report of terminal electrical activity in paediatric patients dying in hospital documented bradycardic arrest in 88% of neonates, 67% of infants, and 64% of children.5 Ventricular tachycardia or fibrillation was more likely in those with heart disease and in older children. The term “sudden death” should not be confused with non-fatal cardiac arrest.w5
Sudden cardiac death in infancy
Sudden death in infancy is usually caused either by infection or by sudden infant death syndrome. A few neonatal or infant deaths are caused by unrecognised congenital cardiovascular malformations, particularly duct dependent abnormalities or obstructive left heart malformations.w6 Primary arrhythmias are rare causes of death in infancy but fatal ventricular arrhythmias are described.6 Complete atrioventricular block is usually recognised in utero or soon after birth but may cause death if unrecognised or untreated.w7
Sudden death in children with postoperative congenital heart disease
In the 1960s and 1970s sudden cardiac death most often occurred in children with irreversible pulmonary vascular disease associated with unoperated …
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