14th International Congress
THE "NEW FRONTIERS"
OF ARRHYTHMIAS 2000

Jan. 29 - Feb. 5, 2000
Marilleva, Trento, Italy

RT-23

Sudden arrhythmicdeath in young people: warning symptoms and pathologic substrates

Silvia G. Priori, Marina Cerrone.
Molecular Cardiology, IRCCS Fondazione Salvatore Maugeri, Pavia, Cardiology Division, IRCCS, Policlinico S. Matteo Hospital, Pavia, Italy

Abstract

BACKGROUND. The aim of the present study was to assess occurrence and type of prodromal symptoms preceding sudden arrhythmic death (SAD) in young people and to determine relation to the underlying pathologic substrates.

METHODS AND RESULTS. From 1979 to 1998, clinical history and autopsy findings were prospectively analysed in 236 young SAD victims (172 males, 64 females, aged 1 to 35 years, mean 23±8). One hundred and twenty-one (52%) patients experienced prodromal symptoms within 2 years preceding SAD; in the other 115 patients SAD was the first manifestation of disease. One hundred and eleven (47%) patients had one or more of the following minor symptoms: palpitations in 59, dizziness in 28, weakness in 22, effort dyspnea in 20, and non specific chest pain in 11. Major, warning prodroma occurred in 59 (25%) patients and consisted of syncope in 53 (exercise-related in 33 and recurrent in 13), and transient cardiac arrest in 6. Morphologic study of the heart included detailed gross examination as well as histologic investigation of ordinary myocardium and specialized conduction system by serial sections. SAD was ascribed to cardiomyopathy in 67 pts (arrhythmogenic right ventricular cardiomyopathy in 36, hypertrophic cardiomyopathy in 18, dilated cardiomyopathy in 12, and restrictive cardiomyopathy in 1), atherosclerotic coronary artery disease in 54, valve disease in 32, non-atherosclerotic coronary artery disease in 29, myocarditis in 27, conduction system pathology in 22, and postoperative congenital heart disease in 5. Although minor symptoms were unrelated to the underlying cardiac disease, syncope and cardiac arrest were significantly (p<0.01) associated with cardiomyopathies, and conduction system abnormalities.

CONCLUSIONS. In our series, 52% of young SAD victims had experienced prodromal symptoms before the fatal event. Syncope and transient cardiac arrest preceded 25% of SAD and were significantly related to cardiomyopathy and conduction system pathology.

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