Sudden cardiac death in children and adolescents between 1 and 19 years of age

Abstract

Background: Understanding pediatric sudden cardiac death (SCD) may inform age-specific prevention strategies.

Objective: To characterize potential underlying causes of SCD in children and adolescents

Methods: We performed a retrospective population-based study in Ontario, Canada, of all SCD cases in a 5-year period (2005-2009) involving persons aged 1-19 years identified from the comprehensive database of the Office of the Chief Coroner. Of 1204 coroner's cases, 351 potential SCD cases were reviewed.

Results: Of 116 cases of adjudicated SCD, there was no identifiable cause of death in 60 (52%). The majority were males (66%), and median age was 12.7 years. The incidence of SCD was greatest between 1 and 2 years (3.14 per 100,000 person-years), decreased, and then increased to 1.01 per 100,000 person-years (15-19 years). Autopsy findings were normal in 29 of 35 (83%) of children younger than 5 years and were more likely to be abnormal in those 10 years and older (odds ratio 9.0; 95% confidence interval 3.3-24.9). In 9%, the pathology findings may be of uncertain significance. Most events occurred in the home (68%). Activity level at the time of the event was associated with both age group (χ(2) = 34.9; P < .001) and autopsy findings (χ(2) = 28.9; P < .001). Events during moderate or vigorous activity were more common in those older than 10 years 16 of 66 (24%), and the majority had abnormal autopsy findings 13 of 18 (72%).

Discussion: Death in the very young is often caused by presumed primary arrhythmia syndromes, and death during exertion is typically seen in those with structural heart disease.

Conclusion: These differences should inform age-specific diagnostic and prevention strategies.

Keywords: ADL; ARVC; CI; CPVT; Death (sudden); ECG; Epidemiology; HCM; IQR; LQTS; MET; OCCO; OR; Office of the Chief Coroner of Ontario; Pediatrics; SCD; SHD; SNH/PAS; SUD; activity of daily living; arrhythmogenic right ventricular cardiomyopathy; catecholaminergic polymorphic ventricular tachycardia; confidence interval; electrocardiogram/electrocardiography; hypertrophic cardiomyopathy; interquartile range; long QT syndrome; metabolic equivalent; odds ratio; structural heart disease; structurally normal heart/presumed primary arrhythmia syndrome; sudden cardiac death; sudden unexpected death.