Aortic Hypoplasia in Young Adult Patients with Sudden Intrinsic Cardiopulmonary Arrest: An Observational Study

Abstract Background: The leading cause of sudden cardiac death in adults over 40 is ischemic heart disease due to vascular atherosclerosis. In contrast, sudden cardiac death in adults younger than 40 (young adults) may be caused by aortic hypoplasia (AH). To date, few detailed studies of AH exist. This study evaluated AH patients in our hospital for sudden cardiopulmonary arrest in young adults. Methods: We selected young adult patients who transferred to our center with cardiopulmonary arrest status between April 2010 and March 2020. Their cause of death was supposed to be cardiac or unknown. In the chart review, sex, age, rate of computed tomography (CT) being performed, and outcome were described. For patients with CT being performed, we assessed the diameters of the aortic root, ascending, descending and abdominal aorta, and right femoral artery.Results: There were 1268 cardiopulmonary arrest cases during the study period. Thirteen young adults died of intrinsic diseases, such as sudden cardiac death or unknown cause of death. Twelve patients underwent CT scans, and eight (61.5%) had AH.Conclusions: For a decade, 61.5% of young adults who died of intrinsic diseases had AH. Further studies should be conducted to reveal AH’s clinical significance in young adults.

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Quality of Life in Young Adult Patients with a Cardiogenetic Condition Receiving an ICD for Primary Prevention of Sudden Cardiac Death

Pacing and Clinical Electrophysiology ◽

10.1111/pace.12649 ◽

2015 ◽

Vol 38 (7) ◽

pp. 870-877 ◽

Cited By ~ 6

Author(s):

AGNES J. VERKERK ◽

ALEXA M. VERMEER ◽

ELLEN M. SMETS ◽

LUKAS R. DEKKER ◽

ARTHUR A. WILDE ◽

...

Keyword(s):

Quality Of Life ◽

Young Adult ◽

Primary Prevention ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Adult Patients

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Sudden cardiac death rates in an Australian population: a data linkage study

Australian Health Review ◽

10.1071/ah14226 ◽

2015 ◽

Vol 39 (5) ◽

pp. 561 ◽

Cited By ~ 3

Author(s):

Jia-Li Feng ◽

Siobhan Hickling ◽

Lee Nedkoff ◽

Matthew Knuiman ◽

Christopher Semsarian ◽

...

Keyword(s):

Public Health ◽

Cardiovascular Disease ◽

Heart Disease ◽

Sudden Cardiac Death ◽

Cause Of Death ◽

Cardiac Death ◽

Linkage Study ◽

Mortality Data ◽

Prevention Measures ◽

Hospital Morbidity

Objective The aim of the present study was to develop criteria to identify sudden cardiac death (SCD) and estimate population rates of SCD using administrative mortality and hospital morbidity records in Western Australia. Methods Four criteria were developed using place, death within 24 h, principal and secondary diagnoses, underlying and associated cause of death, and/or occurrence of a post mortem to identify SCD. Average crude, age-standardised and age-specific rates of SCD were estimated using population person-linked administrative data. Results In all, 9567 probable SCDs were identified between 1997 and 2010, with one-third aged ≥35 years having no prior admission for cardiovascular disease. SCD was more frequent in men (62.1%). The estimated average annual crude SCD rate for the period was 34.6 per 100 000 person-years with an average annual age-standardised rate of 37.8 per 100 000 person-years. Age-specific standardised rates were 1.1 per 100 000 person-years and 70.7 per 100 000 person-years in people aged 1–34 and ≥35 years, respectively. Ischaemic heart disease (IHD) was recorded as the underlying cause of death in approximately 80% of patients aged ≥35 years, followed by valvular heart disease and heart failure. IHD was the most common cause of death in those aged 1–34 years, followed by unspecified cardiomyopathy and dysrhythmias. Conclusions Administrative morbidity and mortality data can be used to estimate rates of SCD and therefore provide a suitable methodology for monitoring SCD over time. The findings highlight the magnitude of SCD and its potential for public health prevention. What is known about the topic? There is considerable variability in rates of SCD worldwide. Different data sources and varied methods of case ascertainment likely contribute to this variation. What does this paper add? The rate of SCD in Australia is low compared with international estimates from USA, Ireland, Netherlands and China. Two in every three cases of SCD aged ≥35 years had a hospitalisation history of cardiovascular disease, highlighting the opportunity for prevention. What are the implications for practitioners? High-quality person-linked administrative hospital morbidity and registered mortality data can be used to estimate rates of SCD in the population. Understanding the magnitude and distribution of SCD is imperative for developing effective public health policy and prevention measures.

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Evaluating Opioid Dispensing Rates among Pediatrics and Young Adults based on CURES Data Reporting in California from 2015-2019

Journal of Contemporary Pharmacy Practice ◽

10.37901/jcphp20-00012 ◽

2021 ◽

Vol 67 (4) ◽

pp. 23-32

Author(s):

Michael Phan ◽

Courtney Wong ◽

Daniel Tomaszewski ◽

Zeev Kain ◽

Brooke Jenkins ◽

...

Keyword(s):

Young Adults ◽

Young Adult ◽

Evaluation System ◽

Age Groups ◽

Secondary Analysis ◽

Adult Patients ◽

High Rate ◽

Utilization Review ◽

Opioid Use ◽

Prescription Rates

Background Receipt of opioid prescriptions in pediatric and young adult patients may be a risk factor for future opioid misuse. Data from prescription drug monitoring programs provide insight on outpatient opioid use. In our study, we analyzed the opioid dispensing rates for pediatrics and young adults in California. Methods A secondary analysis was performed from 2015-2019 using Controlled Utilization Review and Evaluation System data. This database provides dispensing data of controlled substances in California. Patients younger than 25 years who were prescribed opiates were analyzed by county. We further divided them into two groups (children: ≤14 years; adolescents and young adult: 15-24 years). Descriptive statistics and heat maps were used to illustrate the trends in opioid usage among different age groups. Results The overall percentages for the number of opioids being dispensed to patients aged <25 years have decreased over the past four years. In 2015, 6 out of 58 counties in California were considered “high-rate” with >2.9% of opioids dispensed to patients younger than 25 years old; in 2019, this number reduced to zero. Patients 25 and older received a higher proportion of opioids compared to younger populations; in 2019, 35.91% of opioids were dispensed to patients 45-64, and 8.92% to patients younger than 25. Conclusion Pediatric opioid prescriptions have declined over the recent years. However, a high degree of variability of prescription rates between demographic counties was noted. More studies are warranted in order to understand this discrepancy in opioid prescribing among pediatric and young adult patients.

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Abstract 15416: Longitudinal Assessment of Electrical-Mechanical Interactions in Children and Young Adults With Repaired Tetralogy of Fallot

Circulation ◽

10.1161/circ.142.suppl_3.15416 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Suellen M Yin ◽

Laura M Mercer-rosa ◽

Jungwon Min ◽

Elizabeth Goldmuntz ◽

Victoria L Vetter

Keyword(s):

Young Adults ◽

Sudden Cardiac Death ◽

Right Ventricular ◽

Tetralogy Of Fallot ◽

Cardiac Death ◽

Volume Ratio ◽

Rate Of Change ◽

Ventricular Ectopy ◽

Repaired Tetralogy Of Fallot ◽

Over Time

Introduction: Electrical-mechanical interactions contribute to arrhythmias, sudden cardiac death, and right ventricular remodeling in repaired tetralogy of Fallot (TOF). Hypothesis: There are significant changes in electrocardiographic properties and electrical-mechanical interactions that occur over time after complete TOF repair and with pulmonary valve replacement (PVR). Methods: This retrospective cohort study of 177 patients, initially recruited for a cross-sectional research protocol, underwent complete TOF repair at 0.3±0.9 years with 21.5±4.2 years of clinical follow-up. We assessed ECG, Holter, cardiopulmonary exercise testing (CPET), and MRI data. We used linear mixed effects models to examine QRS duration (QRSd) and its rate of change over time, associations between comparable ECG and MRI, Holter and MRI, ECG and Holter, ECG and CPET, and pre-PVR and post-PVR results. Results: QRSd increased after TOF repair, but the rate of change decreased from 5.2 ms/year 1 year post-operatively to 1.7 ms/year 20 years post-operatively. Twenty years from TOF repair, post-operative arrhythmias included ventricular ectopy: ventricular tachycardia (4 of 20 patients) on Holter and premature ventricular contractions (14 of 19 patients) on CPET. QRSd was positively associated with right ventricular (RV) volumes, RV:left ventricular (LV) end-diastolic volume ratio, and complex ventricular ectopy on Holter; and negatively associated with RV ejection fraction (EF). The association between QRSd and RV volumes was weaker post-PVR. QRSd and its rate of change were associated with increased LV volume post-PVR. Complex ventricular ectopy was associated with lower LV EF, and significant atrial ectopy was associated with higher LV mass-to-volume ratio. Conclusions: Substantial ventricular ectopy occurs in adolescents and young adults after repair of TOF. Electrophysiologic changes included QRSd prolongation that progressively slowed. QRSd and its rate of change were associated with published risk factors for arrhythmia and sudden cardiac death, and with indications for PVR. Our ongoing research aims to identify an optimal threshold of pre-PVR QRSd and its rate of change that preserves bi-ventricular electrical-mechanical coupling post-PVR.

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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 Adult Patients with Stable Ischemic Heart Disease

Cardiovascular Innovations and Applications ◽

10.15212/cvia.2016.0007 ◽

2019 ◽

Vol 3 (3) ◽

pp. 317-319

Author(s):

C. Richard Conti

Keyword(s):

Heart Disease ◽

Sudden Cardiac Death ◽

Ischemic Heart Disease ◽

Cardiac Death ◽

Adult Patients ◽

Ischemic Heart ◽

Stable Ischemic Heart Disease

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Incidence and Etiology of Sudden Cardiac Death: New Updates for Athletic Departments

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738117694153 ◽

2017 ◽

Vol 9 (3) ◽

pp. 268-279 ◽

Cited By ~ 19

Author(s):

Irfan M. Asif ◽

Kimberly G. Harmon

Keyword(s):

African Americans ◽

Sudden Cardiac Death ◽

Cause Of Death ◽

Cardiac Death ◽

The United States ◽

Common Finding ◽

Normal Heart ◽

Basketball Players ◽

Sudden Unexplained Death ◽

Unexplained Death

Context: Sudden cardiac death (SCD) in a young athlete is a tragic event and is the leading medical cause of death in this population. The precise incidence of SCD in young athletes has been subject of debate, with studies reporting drastically different rates (1:917,000 athlete-years (AYs) to 1:3000 AYs) depending on the methodological design of the investigation or the targeted population. Evidence Acquisition: A literature search was performed in PubMed using the terms: incidence, sudden cardiac death, sudden death, sudden cardiac arrest, etiology, pathology, registry, athlete, young, children, and adolescents. Articles were reviewed for relevance and included if they contained information on the incidence of SCD in athletes or young persons up to the age of 35 years. Study Design: Clinical review. Level of Evidence: Level 5. Results: Studies of high quality and rigor consistently yield an incidence of 1:50,000 AYs in college athletes and between 1:50,000 and 1:80,000 AYs for high school athletes, with certain subgroups that appear to be at particularly high risk, including the following: men, basketball players, and African Americans. Initial reports suggest that the most common cause of SCD is hypertrophic cardiomyopathy (HCM). However, more comprehensive investigations in the United States and international populations—athletes, nonathletes, and military—support that the most common finding on autopsy in young individuals with SCD is actually a structurally normal heart (autopsy-negative sudden unexplained death). Conclusion: SCD is the leading cause of death in athletes during exercise and usually results from intrinsic cardiac conditions that are triggered by the physiologic demands of vigorous exercise. Current rates of SCD appear to be at least 4 to 5 times higher than previously estimated, with men, African Americans, and male basketball players being at greatest risk. Emerging data suggest that the leading finding associated with SCD in athletes is actually a structurally normal heart (autopsy-negative sudden unexplained death).

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