Motivation to Pursue Genetic Testing in Individuals with a Personal or Family History of Cardiac Events or Sudden Cardiac Death

Introduction. There is little information on the specific risk factors leading to sudden cardiac death (SCD) during an acute coronary event, because the risk variables may overlap with those of non-fatal coronary event. This study was designed to compare the risk profiles of SCD victims and survivors of an acute coronary event. Methods and Results. A case-control study included consecutive victims of SCD (n=425, mean age 64±11 years) verified to be due to an acute coronary event at medicolegal autopsy and consecutive patients surviving an acute myocardial infarction (AMI, n=644, mean age 62±10 years). Common cardiovascular risk factors, cardiac hypertrophy, and severity of coronary artery disease (CAD) were assessed in both groups. Family history of SCD (odds ratio 1.5, 95% CI 1.0 to 2.2, p=0.03), male gender (odds ratio 1.8, 95% CI 1.3 to 2.4, p<0.001), current smoking (odds ratio 2.0, 95% CI 1.5 to 2.6, p<0.001), cardiac hypertrophy (odds ratio 3.0, 95% CI 2.3 to 3.9, p<0.001) and 3-vessel CAD (odds ratio 5.4, 95% CI 3.6 to 8.2, p<0.001) were more common among the victims of SCD as compared to survivors of AMI. On the contrary, history of hypercholesterolemia (p<0.001) was less common among the SCD victims. There was a cumulative increase of risk of being a SCD victim vs. AMI survivor when more than one risk factor was present, the odds ratio being 44.3 (95% CI 8.0 to 246.7) in a current male smoker with a family history of SCD and cardiac hypertrophy. When 3-vessel CAD was added to the combined risk score, all subjects (7% of the SCD victims) were in the group of SCD giving a 100% sensitivity and specificity, respectively, in differentiating between the SCD victims and AMI survivors. Conclusions. There are specific features that differentiate the victims of SCD from survivors of an acute coronary event. Clustering of several variables, such as family history of SCD, smoking, cardiac hypertrophy, and 3-vessel CAD indicate a very high risk of SCD.

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P1000Aetiology and efficacy of atrial fibrillation ablation in young adults

EP Europace ◽

10.1093/europace/euaa162.001 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

R Zhang ◽

I T Fazmin ◽

A Porto ◽

K Divulwewa ◽

A Reddy ◽

...

Keyword(s):

Atrial Fibrillation ◽

Young Adults ◽

Family History ◽

Sudden Cardiac Death ◽

Pulmonary Vein ◽

Cardiac Death ◽

Univariate Analysis ◽

Pulmonary Vein Stenosis ◽

Af Ablation ◽

History Of

Abstract Introduction Little is known regarding the aetiology or outcome of atrial fibrillation (AF) occurring in young adults. This retrospective analysis was performed to explore the demographics and efficacy of AF ablation in this population. Methods Patients were included who had undergone ≥1 AF ablation under the age of 40 between 2006-2018. Recurrence was defined as return of either documented AF or previous symptoms for >30s following a 3-month blanking period. Initial exploratory co-variates were included in a univariate analysis and those terms with P-value of <0.1 were then used to generate a Cox proportional-hazards multivariate model. Results 124 patients (33.6 ± 4.7 yrs, 77% men), initially presenting with paroxysmal AF (pAF; n = 97) or persistent AF (n = 27), underwent 175 AF ablation procedures. 22.6% (n = 28) also had atrial flutter. Time from symptom onset to first ablation was 50.7 ± 46.2 months. Relevant cardiovascular-related demographics were analysed: hypertension in 8.9% (n = 11); diabetes in 1.6% (n = 2); positive family history of AF in 12.9% (n = 16); and family history of sudden cardiac death in 2.4% (n = 3). Mean CHA2DS2-VASc score was 0.35. Of those patients with documented echocardiogram imaging (n = 91), 26.4% (n = 24) had LA dilatation and 6.6% (n = 6) had LV dysfunction. Patients with LA dilatation underwent more ablations (2.3 ± 0.3) compared to controls (1.5 ± 0.1; p < 0.001). Ablation strategy was pulmonary vein isolation (PVI) only in 67.2% (n = 119), with additional ablation in the remaining: roof line in 18.9% (n = 33); cavotricuspid isthmus line in 13.1% (n = 23); mitral isthmus line in 2.3% (n = 4); superior vena cava isolation in 2.3% (n = 4); complex fractionated atrial electrograms in 14.9% (n = 26). Mean procedure time was 155 ± 41 min, mean ablation time was 1657 ± 991 s and mean fluoroscopy time was 32.6 ± 23.4 min. General anaesthesia was used in 43.4% (n = 76). Complications included femoral haematoma (n = 2), tamponade (n = 1) and pulmonary vein stenosis (n = 2). 90 days of follow-up was available for 137 procedures performed for pAF (n = 105) and persistent AF (n = 32). For pAF, overall recurrence was 61.9% for first ablations and 62.9% overall. Recurrence was 56.3% for persistent AF. Factors significantly associated with increased AF recurrence in univariate analysis were male gender (hazard ratio (HR) 2.3, 95% confidence interval (CI): 1.2-4.4, p = 0.011), hypertension (HR 0.5, CI: 0.2-1.1, p = 0.067), family history of sudden cardiac death (HR 6.8, CI: 1.6-29.0 , p = 0.010) and enlarged LA size (HR 2.2, CI: 1.3-3.6, p = 0.003). In multivariate analysis, the only significant predictor of poor outcome was enlarged LA size (HR 2.0, 95% CI: 1.2-3.5, p = 0.011). Conclusions Young patients with AF may have structurally abnormal hearts, and therefore do not only present with lone AF. LA size may be used as a predictor for success. Surveillance imaging may be useful to detect future structural change, which will be the subject of future prospective studies. Abstract Figure. AF ablation recurrence in young adults

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Appropriate use of genetics in a young patient with atrioventricular block and family history of sudden cardiac death

HeartRhythm Case Reports ◽

10.1016/j.hrcr.2018.12.004 ◽

2019 ◽

Vol 5 (3) ◽

pp. 169-172 ◽

Cited By ~ 1

Author(s):

Johnni Rudbeck-Resdal ◽

Jens Cosedis Nielsen ◽

Henning Bundgaard ◽

Henrik K. Jensen

Keyword(s):

Family History ◽

Sudden Cardiac Death ◽

Young Patient ◽

Atrioventricular Block ◽

Cardiac Death ◽

Appropriate Use ◽

History Of

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P585Intramural haemangioma of the interventricular septum in a patient with strong family history of sudden cardiac death

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez108.021 ◽

2019 ◽

Vol 20 (Supplement_2) ◽

Author(s):

A Piccoli ◽

E Pomiato ◽

G Golia ◽

G Destro ◽

G Cacici ◽

...

Keyword(s):

Family History ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Interventricular Septum ◽

Strong Family History ◽

History Of

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Exercise-Related QT Interval Shortening with a Peaked T Wave in a Healthy Boy with a Family History of Sudden Cardiac Death

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2012.03363.x ◽

2012 ◽

Vol 35 (8) ◽

pp. e239-e242 ◽

Cited By ~ 4

Author(s):

MASAOMI CHINUSHI ◽

AKINORI SATO ◽

KENICHI IIJIMA ◽

KATUYA SUZUKI ◽

FURUSHIMA HIROSHI ◽

...

Keyword(s):

Family History ◽

Sudden Cardiac Death ◽

Qt Interval ◽

Cardiac Death ◽

T Wave ◽

History Of

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Congenital absence of pericardium: a nomad heart

Cardiology in the Young ◽

10.1017/s1047951114002273 ◽

2014 ◽

Vol 25 (7) ◽

pp. 1415-1417

Author(s):

Liliana Marta ◽

António M. Ferreira ◽

Katya R. Santos

Keyword(s):

Family History ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Congenital Absence ◽

Medical Attention ◽

Cardiac Malformation ◽

Cardiac Defect ◽

History Of

AbstractCongenital pericardial absence is a rare cardiac defect. Although most patients are asymptomatic, recognising this condition is clinically important as it can cause serious complications. We report the case of an asymptomatic 33-year-old woman seeking medical attention due to a family history of sudden cardiac death. The investigation led us to the diagnosis of congenital absence of the pericardium. The role of imaging in the diagnosis of this rare cardiac malformation is briefly discussed.

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Predictors of sudden cardiac arrest in adolescents with mitral valve prolapse: an analysis of the nationwide inpatient sample

European Heart Journal ◽

10.1093/ehjci/ehaa946.2007 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

B Narasimhan ◽

L Wu ◽

C.H Lucas ◽

K Bhatia ◽

A Shah ◽

...

Keyword(s):

Cardiac Arrest ◽

Family History ◽

Sudden Cardiac Death ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Prolapse ◽

Cardiac Death ◽

Sudden Cardiac Arrest ◽

Adolescent Patients ◽

History Of

Abstract Background Mitral valve prolapse (MVP) is the most commonly encountered valvular pathology seen in 2–3% of the general population. Though traditionally regarded as a benign pathology, recent literature suggests that sudden cardiac death is significantly more common in these patients with estimates of 0.2–0.4%/year. The exact underlying mechanism of these higher rates of SCD remain poorly understood. In this study, we aim to identify predictors of sudden cardiac arrest (SCA) in an adolescent population. Methods We conducted a retrospective study using the AHRQ-HCUP National Inpatient Sample 2016-2017 for the years 2016-17. All patients (≤18 years) admitted with Mitral valve prolapse were identified using ICD-10 codes and further sub stratified based on presence or absence of sudden cardiac arrest (SCA). Baseline characteristics were obtained and multivariate regression analysis was utilized to identify potential predictors of SCA. Independent risk factors for in-hospital mortality were identified using a proportional hazards model. Complications were defined as per the Agency for Health Care Research and Quality guideline. Results We screened a total of 71,473,874 admissions in the NIS database to identify a total of 1,372 adolescent patients admitted with MVP in the years 2016–17. These patients were then sub-categorized based on presence or absence of SCA during the hospitalization. Our findings revealed that patients with SCA were generally slightly older (15y vs 13y, p=0.036, OR-1.1, p=0.007) and more likely female (83.3% vs 13%, p=0.227, OR – 3.55, p=0.57)). Interestingly, patients in the SCA cohort were noted to have almost 4 fold higher rates of Mitral regurgitation (66.6% vs 18.35%, p=0.008, OR-8.89, p=0.005) as well as family history of SCD (16.7% vs 4.1%, p=0.145, OR-4.65, p=0.14). Conclusions Presence of Mitral regurgitation and a family history of sudden cardiac death are associated with significantly higher rates of SCA in adolescent patients with mitral valve prolapse. Predictors of SCA in Adolescent MVP Funding Acknowledgement Type of funding source: None

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A comprehensive work up of various ventricular tachy-arrhythmias in relation to the underling cardiac disorder / status

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20174161 ◽

2017 ◽

Vol 5 (10) ◽

pp. 4292

Author(s):

Tusharkanti Patra ◽

Prashant Kumar ◽

Somnath Mukherjee ◽

Anurag Passi ◽

S. K. Saidul Islam

Keyword(s):

Heart Disease ◽

Family History ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Heart Diseases ◽

Ventricular Tachyarrhythmia ◽

Triple Vessel Disease ◽

History Of ◽

Ventricular Tachy ◽

Work Up

Background: Main objective of the study is details work up of the patients of ventricular tachy-arrhythmias and to find out its association with any structural heart disease.Methods: This institution based observational study was conducted in patients of documented sustained VT (ventricular tachycardia) with consecutive 102 patients.Results: The mean age of the VT patients was 56.7 years and the number of male patients were 70 (69%). In our study, among 102 patients 45 patients were diabetic, 64 patients were hypertensive, 30 patients were current smoker, family history of heart disease was present in 25 patients and family history of SCD (sudden cardiac death) was present in 5 patients. Among the patients who presented with symptoms of ventricular tachy arrhythmia, 25 patients had EF (ejection fraction) above 40%, 36 had EF between 31 to 40% and only 2 had EF below 30%. CAG (coronary angiography) done in 98 patients and 16 had normal coronaries. 20, 16 and 46 patients had single, double and triple vessel disease respectively. 80 patients had coronary heart disease (78%), 20 patients among them had acute ischemic events and 60 had chronic ischemic disease. 12 patients didn’t have any structural heart disease.Conclusions: Ischemic heart disease, acute or chronic, is the most common causes of ventricular tachyarrhythmia. male sex, diabetes mellitus, hypertension, smoking, family history of heart diseases or sudden cardiac death being the risk factors of coronary artery disease are also predisposing factors of ventricular tachyarrhythmia.

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