Value of electrocardiographic screening for the early diagnosis of arrhythmic and malignant heart disease in pediatric age

Abstract Funding Acknowledgements Type of funding sources: None. Background The 12-lead electrocardiogram (ECG) is an instrument that can identify cardiac conduction system abnormalities that predispose to sudden cardiac death (SCD) in completely asymptomatic subjects. The rate of sudden cardiac death in pediatric age is estimated to be around 1-1.5 cases per 100.000 individuals, and 10-15% of events occur during physical activity. We evaluated the importance of the electrocardiogram performed in pediatric age in the early detection of asymptomatic electrocardiographic alterations, suggestive for the presence of electrical or structural heart disease potentially at risk for sudden death. Materials and Methods We analyzed 623 patients between 0 and 16 years of age who were sent to the second level pediatric arrhythmology clinic in Padua Hospital between October 2013 and March 2020. The patients were redirected at our clinic after a first finding of electrocardiographic alterations, following ECG performed before the beginning of sport activity, suspected of life-threatening pathologies. The following parameters were evaluated of all patients: clinical suspect of sending the pediatric arrhythmology clinic and electrocardiogram. Then, depending on the type of pathology suspected, the following diagnostic tests were carried out to confirm the clinical suspicion, and if confirmed, to carry out an adequate risk stratification: Holter ECG, ergometric Results Among the evaluated population (623 patients), 393 patients (63%) were sent to the pediatric arrhythmology clinic by sports medicine, 179 (29%) were sent by clinical o family pediatrician, and 51 patients (8%) were sent after ECG performed at hospital facilities for familiarity. The majority, 280 patients (45%), were sent for suspected WPW; 124 patients (20%) were sent for BEV and suspected ARVD; 85 patients (14%) for suspected long QT, 31 patients (5%) for suspected Brugada Pattern; 7 patients (1%) suspected CPVT; 8 patients (1%) for electrocardiographic changes with suspected HCM; 1 patient (0.01%) suspected shortened QT, and 88 patients (14%) for other arrhythmic disorders not at risk of sudden death. The diagnosis of WPW was confirmed in 280 patients, LQTS in 45 patients, SQTS in 1 patient, S. di Brugada in 8 patients, CPVT in 5 patients, HCM in 8 patients and ARVD in 6 patients. Conclusions Our study shows that the electrocardiographic screening already in pediatric age allows the diagnosis and subsequent early treatment of life-threatening arrhythmic heart diseases.

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Recent advances in understanding and prevention of sudden cardiac death

F1000Research ◽

10.12688/f1000research.11855.1 ◽

2017 ◽

Vol 6 ◽

pp. 1614 ◽

Cited By ~ 3

Author(s):

Jamie I. Vandenberg ◽

Matthew D. Perry ◽

Adam P. Hill

Keyword(s):

Heart Disease ◽

Sudden Cardiac Death ◽

Sudden Death ◽

Cause Of Death ◽

Cardiac Death ◽

Recent Literature ◽

Heart Diseases ◽

Cardiac Arrhythmogenesis ◽

Underlying Mechanisms ◽

Genetic Heart Disease

There have been tremendous advances in the diagnosis and treatment of heart disease over the last 50 years. Nevertheless, it remains the number one cause of death. About half of heart-related deaths occur suddenly, and in about half of these cases the person was unaware that they had underlying heart disease. Genetic heart disease accounts for only approximately 2% of sudden cardiac deaths, but as it typically occurs in younger people it has been a particular focus of activity in our quest to not only understand the underlying mechanisms of cardiac arrhythmogenesis but also develop better strategies for earlier detection and prevention. In this brief review, we will highlight trends in the recent literature focused on sudden cardiac death in genetic heart diseases and how these studies are contributing to a broader understanding of sudden death in the community.

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Brugada Syndrome: Fatal Consequences of a Must-Not-Miss Diagnosis

Critical Care Nurse ◽

10.4037/ccn2021499 ◽

2021 ◽

Vol 41 (5) ◽

pp. 15-22

Author(s):

L. Douglas Smith ◽

Sarah Gast ◽

Danielle F. Guy

Keyword(s):

At Risk ◽

Critical Care ◽

Sudden Cardiac Death ◽

Ventricular Arrhythmia ◽

Brugada Syndrome ◽

Cardiac Death ◽

Lifestyle Modification ◽

Genetic Disorder ◽

Cardiac Conduction ◽

St Segment Elevation

Background Brugada syndrome is a genetic disorder of cardiac conduction that predisposes patients to spontaneous ventricular arrhythmia and sudden cardiac death. Although Brugada syndrome is one of the most common causes of sudden cardiac death, patients presenting with the syndrome often go misdiagnosed. This error has potentially fatal consequences for patients, who are at risk for sudden cardiac death without appropriate management. Objective To increase the critical care professional’s knowledge of Brugada syndrome through detailed description of the characteristic electrocardiographic findings, an algorithmic approach to electrocardiogram evaluation, and a case report of a patient with a previously missed diagnosis of Brugada syndrome. The essential concepts of epidemiology, pathophysiology, clinical presentation, risk stratification, and management are reviewed for critical care professionals who may encounter patients with the syndrome. Diagnosis Patients typically present with syncope or cardiac arrest and an abnormal electrocardiographic finding of ST-segment elevation in the precordial leads. The diagnosis of Brugada syndrome centers on identification of its electrocardiographic characteristics by critical care professionals who routinely evaluate electrocardiograms. Critical care professionals, especially nurses and advanced practice nurses, should be proficient in recognizing the electrocardiographic appearance of Brugada syndrome and initiating appropriate management. Interventions Management strategies include prevention of sudden cardiac death through lifestyle modification and placement of an implantable cardioverter-defibrillator. Critical care professionals should be aware of commonly used medications that may exacerbate ventricular arrhythmia and place patients at risk for sudden cardiac death. Conclusion Increased awareness of Brugada syndrome among critical care professionals can decrease patient morbidity and mortality.

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Dealing with Sudden Cardiac Death: Who Deserves Device Implantation

ACI (Acta Cardiologia Indonesiana) ◽

10.22146/aci.47675 ◽

2019 ◽

Vol 5 (1 (P)) ◽

pp. 12

Author(s):

Dicky Armein Hanafy

Keyword(s):

Heart Failure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Sudden Cardiac Death ◽

Cardiac Arrhythmias ◽

Cardiac Death ◽

Cardiac Insufficiency ◽

Resynchronization Therapy ◽

Icd Implantation ◽

Life Threatening

Sudden cardiac death is one of the leading causes of death in the western industrial nations. Most people are affected by coronary heart disease (coronary heart disease, CHD) or heart muscle (cardiomyopathy). These can lead to life-threatening cardiac arrhythmias. If the heartbeat is too slow due to impulse or conduction disturbances, cardiac pacemakers will be implanted. High-frequency and life-threatening arrhythmias of the ventricles (ventricular tachycardia, flutter or fibrillation) cannot be treated with a pacemaker. In such cases, an implantable cardioverter-defibrillator (ICD) is used, which additionally also provides all functions of a pacemaker. The implantation of a defibrillator is appropriate if a high risk of malignant arrhythmias has been established (primary prevention). If these life-threatening cardiac arrhythmias have occurred before and are not caused by a treatable (reversible) cause, ICD implantation will be used for secondary prevention. The device can stop these life-threatening cardiac arrhythmias by delivering a shock or rapid impulse delivery (antitachycardic pacing) to prevent sudden cardiac death. Another area of application for ICD therapy is advanced heart failure (heart failure), in which both main chambers and / or different wall sections of the left ventricle no longer work synchronously. This form of cardiac insufficiency can be treated by electrical stimulation (cardiac resynchronization therapy, CRT). Since the affected patients are also at increased risk for sudden cardiac death, combination devices are usually implanted, which combine heart failure treatment by resynchronization therapy and the prevention of sudden cardiac death by life-threatening arrhythmia of the heart chambers (CRT-D device). An ICD is implanted subcutaneously or under the pectoral muscle in the area of the left collarbone. Like pacemaker implantation, ICD implantation is a routine, low-complication procedure today.

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Secondary prevention of sudden cardiac death in ischaemic cardiomyopathy

ESC CardioMed ◽

10.1093/med/9780198784906.003.0553_update_001 ◽

2018 ◽

pp. 2337-2341

Author(s):

Jens Cosedis Nielsen ◽

Jens Kristensen

Keyword(s):

Heart Failure ◽

Cardiac Arrest ◽

Heart Disease ◽

High Risk ◽

Sudden Cardiac Death ◽

Secondary Prevention ◽

Cardiac Death ◽

Cardioverter Defibrillator ◽

Ischaemic Cardiomyopathy ◽

Life Threatening

The most common reason for sudden cardiac death is ischaemic heart disease. Patients who survive cardiac arrest are at particularly high risk of recurrent ventricular arrhythmia and sudden cardiac death, and are candidates for secondary prevention defined as ‘therapies to reduce the risk of sudden cardiac death in patients who have already experienced an aborted cardiac arrest or life-threatening arrhythmias’. The mainstay therapy for secondary prevention of sudden cardiac death is implantation of an implantable cardioverter defibrillator. Furthermore, revascularization and optimal medical therapy for heart failure and concurrent cardiovascular diseases should be ensured.

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CT and MR Imaging Findings in Patients with Acquired Heart Disease at Risk for Sudden Cardiac Death

Radiographics ◽

10.1148/rg.293085715 ◽

2009 ◽

Vol 29 (3) ◽

pp. 805-823 ◽

Cited By ~ 34

Author(s):

Patrick J. Sparrow ◽

Naeem Merchant ◽

Yves L. Provost ◽

Deirdre J. Doyle ◽

Elsie T. Nguyen ◽

...

Keyword(s):

At Risk ◽

Heart Disease ◽

Sudden Cardiac Death ◽

Mr Imaging ◽

Cardiac Death ◽

Imaging Findings ◽

Acquired Heart Disease

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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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Do ‘pathologic’ cardiac murmurs in adolescents identify structural heart disease? An evaluation of 15 141 active adolescents for conditions that put them at risk of sudden cardiac death

British Journal of Sports Medicine ◽

10.1136/bjsports-2019-101718 ◽

2021 ◽

pp. bjsports-2019-101718

Author(s):

Ashley V Austin ◽

David S Owens ◽

Jordan M Prutkin ◽

Jack C Salerno ◽

Brian Ko ◽

...

Keyword(s):

At Risk ◽

Heart Disease ◽

Sudden Cardiac Death ◽

Positive Predictive Value ◽

Predictive Value ◽

Cardiac Death ◽

Comparison Group ◽

Structural Heart Disease ◽

Cardiac Murmur ◽

Clinical Criteria

ObjectivesWe assessed whether the presence and character of a cardiac murmur in adolescents were associated with structural heart disease that confers risk of sudden cardiac death (SCD).MethodsWe performed a retrospective analysis of 15 141 adolescents age 12–19 who underwent a heart screen with history, physical examination and ECG. Participants with any screening abnormality underwent an echocardiogram for the assessment of structural heart disease. Murmurs were classified as physiological or pathological according to standard clinical criteria, and participants with murmurs were compared with a comparison group without murmurs. The primary outcome was echocardiogram-detected structural heart disease associated with SCD.Results905 participants with a cardiac murmur (mean age 15.8; 58% male) and 4333 participants without a murmur (comparison group; mean age 15.8; 55% male) had an echocardiogram to detect structural heart disease. 743 (82%) murmurs were described as physiological and 162 (18%) as pathological. Twenty-five (2.8%) participants with murmurs and 61 (1.4%) participants without murmurs had structural heart disease. Three (0.3%) participants in the murmur group were diagnosed with hypertrophic cardiomyopathy (HCM) which was the only identified condition associated with SCD. Two participants with HCM had physiological murmurs, one had a pathological murmur, and all three had an abnormal ECG. The most common minor structural heart disease was bicuspid aortic valve in both the murmur (7; 0.8%) and comparison (20; 0.5%) groups. The positive predictive value of physiological versus pathological murmurs for identifying any structural heart disease was 2.4% versus 4.3% (p=0.21), respectively. The positive predictive value of having any murmur versus no murmur for identifying structural heart disease was 2.8% versus 1.4% (p=0.003), respectively.ConclusionsIn adolescents, the traditional classification of cardiac murmurs as ‘physiologic’ or ‘pathologic’ does not differentiate for structural heart disease that puts individuals at risk for SCD. We recommend ECG evaluation in all patients with a cardiac murmur found during preparticipation screening to increase detection of HCM.

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Sudden death of athletes in nursing practice

Medsestra (Nurse) ◽

10.33920/med-05-2003-03 ◽

2020 ◽

pp. 14-19

Author(s):

Sergey Novikov ◽

Daniel Lipov ◽

Vsevolod Skvortsov

Keyword(s):

Sudden Cardiac Death ◽

Sudden Death ◽

Emergency Care ◽

Cardiac Death ◽

Nursing Practice ◽

Preventive Measures ◽

Professional Athletes ◽

Life Threatening

The article deals with the epidemiology and main causes of sudden cardiac death in professional athletes and people participating in sports as amateurs. Pathogenesis of the main nosologies, as well as preventive measures and emergency care in case of life-threatening conditions are described.

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