Abstract 3667: Comparison of Risk Profiles between Survivors and Victims of Sudden Cardiac Death of an Acute Coronary Event

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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Severity of coronary artery disease, cardiac hypertrophy and coronary risk factors in victims of sudden cardiac death caused by an acute coronary event

International Journal of Cardiology ◽

10.1016/j.ijcard.2007.03.017 ◽

2007 ◽

Vol 119 ◽

pp. S6

Author(s):

Kari Kaikkonen ◽

Marja-Leena Kortelainen ◽

Heikki Huikuri

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Coronary Event ◽

Coronary Risk Factors ◽

Coronary Risk ◽

Acute Coronary Event ◽

Artery Disease

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Family History and the Risk of Sudden Cardiac Death as a Manifestation of an Acute Coronary Event

Circulation ◽

10.1161/circulationaha.106.624593 ◽

2006 ◽

Vol 114 (14) ◽

pp. 1462-1467 ◽

Cited By ~ 125

Author(s):

Kari S. Kaikkonen ◽

Marja-Leena Kortelainen ◽

Eeva Linna ◽

Heikki V. Huikuri

Keyword(s):

Family History ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Coronary Event ◽

Acute Coronary Event

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Comparison of risk profiles between survivors and victims of sudden cardiac death from an acute coronary event

Annals of Medicine ◽

10.1080/07853890802213295 ◽

2009 ◽

Vol 41 (2) ◽

pp. 120-127 ◽

Cited By ~ 10

Author(s):

Kari S. Kaikkonen ◽

Marja-Leena Kortelainen ◽

Heikki V. Huikuri

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Coronary Event ◽

Acute Coronary Event ◽

Risk Profiles

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Genotype-Phenotype Correlation of SCN5A Genotype in Patients With Brugada Syndrome and Arrhythmic Events: Insights From the SABRUS in 392 Probands

Circulation Genomic and Precision Medicine ◽

10.1161/circgen.120.003222 ◽

2021 ◽

Author(s):

Anat Milman ◽

Elijah R. Behr ◽

Belinda Gray ◽

David C. Johnson ◽

Antoine Andorin ◽

...

Keyword(s):

Family History ◽

Sudden Cardiac Death ◽

Brugada Syndrome ◽

Odds Ratio ◽

Cardiac Death ◽

Variants Of Unknown Significance ◽

Increased Risk ◽

Cardiac Sodium Channel ◽

Arrhythmic Event ◽

History Of

Background: Brugada syndrome (BrS) is associated with mutations in the cardiac sodium channel gene, SCN5A. However, genetic studies of patients with BrS with arrhythmic events have been limited. We sought to compare various clinical, ECG, and electrophysiological parameters according to SCN5A genotype in a large cohort of BrS probands with first arrhythmic event. Methods: Survey on Arrhythmic Events in Brugada Syndrome is a survey of 10 Western and 4 Asian countries, gathering 678 patients with BrS with first arrhythmic event. Only probands were included, and SCN5A genotype adjudicated. Patients without appropriate genetic data were excluded. Associations of genotype with clinical features were analyzed. Results: The study group comprised 392 probands: 92 (23.5%) SCN5A+ (44 pathogenic/likely pathogenic [P/LP] and 48 variants of unknown significance) and 300 (76.5%) SCN5A−. SCN5A missense variants and the patients hosting them were similar regardless of adjudication. A higher proportion of patients with P/LP were pediatric (<16 years) compared with SCN5A− (11.4% versus 3%, P =0.023). The proportion of females was higher among patients with P/LP compared with SCN5A − (18.2% versus 6.3%, P =0.013). P/LP probands were more likely to have a family history of sudden cardiac death compared with SCN5A − (41.9% versus 16.8%, P <0.001). A higher proportion of patients with P/LP were White compared with SCN5A− (87.5% versus 47%, P <0.001). Ethnicity (odds ratio, 5.41 [2.8–11.19], P <0.001) and family history of sudden cardiac death (odds ratio, 2.73 [1.28–5.82], P =0.009) were independent variables associated with P/LP genotype following logistic regression. Conclusions: The genetic basis of BrS has a complex relationship with gender, ethnicity, and age. Probands hosting a P/LP variant tended to experience their first arrhythmic event at a younger age and to have events triggered by fever compared with patients with SCN5A− . In addition, they were more likely to be White and to have family history of sudden cardiac death. Among females, a P/LP variant suggests an increased risk of being symptomatic. This association should be further studied on an ethnically specific basis in large prospectively collected international cohorts.

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Antiepileptic medications and the risk for sudden cardiac death caused by an acute coronary event: a prospective case-control study

Annals of Medicine ◽

10.3109/07853890.2016.1140225 ◽

2016 ◽

Vol 48 (1-2) ◽

pp. 111-117 ◽

Cited By ~ 3

Author(s):

Eeva Hookana ◽

Hanna Ansakorpi ◽

Marja-Leena Kortelainen ◽

M. Juhani Junttila ◽

Kari S Kaikkonen ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Case Control Study ◽

Coronary Event ◽

Case Control ◽

Acute Coronary Event ◽

Antiepileptic Medications ◽

Control Study ◽

Prospective Case Control Study

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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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Sudden Cardiac Death in the Young

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.119.006470 ◽

2020 ◽

Vol 13 (10) ◽

Cited By ~ 1

Author(s):

Francis J. Ha ◽

Hui-Chen Han ◽

Prashanthan Sanders ◽

Kim Fendel ◽

Andrew W. Teh ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Body Mass Index ◽

Coronary Artery ◽

Sudden Cardiac Death ◽

Odds Ratio ◽

Cardiac Death ◽

Arrhythmic Death ◽

Sudden Arrhythmic Death Syndrome ◽

Artery Disease

Background: Sudden cardiac death (SCD) in the young is devastating. Contemporary incidence remains unclear with few recent nationwide studies and limited data addressing risk factors for causes. We aimed to determine incidence, trends, causes, and risk factors for SCD in the young. Methods and Results: The National Coronial Information System registry was reviewed for SCD in people aged 1 to 35 years from 2000 to 2016 in Australia. Subjects were identified by the International Classification of Diseases , Tenth Revision code relating to circulatory system diseases (I00–I99) from coronial reports. Baseline demographics, circumstances, and cause of SCD were obtained from coronial and police reports, alongside autopsy and toxicology analyses where available. During the study period, 2006 cases were identified (median age, 28±7 years; men, 75%; mean body mass index, 29±8 kg/m 2 ). Annual incidence ranged from 0.91 to 1.48 per 100 000 age-specific person-years, which was the lowest in 2013 to 2015 compared with previous 3-year intervals on Poisson regression model ( P =0.001). SCD incidence was higher in nonmetropolitan versus metropolitan areas (0.99 versus 0.53 per 100 000 person-years; P <0.001). The most common cause of SCD was coronary artery disease (40%), followed by sudden arrhythmic death syndrome (14%). Incidence of coronary artery disease–related SCD decreased from 2001–2003 to 2013–2015 ( P <0.001). Proportion of SCD related to sudden arrhythmic death syndrome increased during the study period ( P =0.02) although overall incidence was stable ( P =0.22). Residential remoteness was associated with coronary artery disease–related SCD (odds ratio, 1.44 [95% CI, 1.24–1.67]; P <0.001). For every 1-unit increase, body mass index was associated with increased likelihood of SCD from cardiomegaly (odds ratio, 1.08 [95% CI, 1.05–1.11]; P <0.001) and dilated cardiomyopathy (odds ratio, 1.04 [95% CI, 1.01–1.06]; P =0.005). Conclusions: Incidence of SCD in the young and specifically coronary artery disease–related SCD has declined in recent years. Proportion of SCD related to sudden arrhythmic death syndrome increased over the study period. Geographic remoteness and obesity are risk factors for specific causes of SCD in the young.

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