National sudden cardiac death autopsy database highlighting sudden arrhythmic death and cardiomyopathies, applying diagnostic criteria and expanding the concept of the molecular autopsy

Abstract

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Cardiac Risk in the Young Background Sudden cardiac death (SCD) is defined as natural unexpected death in witnessed cases occurring <1 hour and in unwitnessed cases as last seen alive <24hours. SCD due to ischaemic heart disease (IHD) is frequent in older age groups, in younger people genetic cardiac causes including channelopathies and cardiomyopathies are more frequent. Purpose To present the causes of SCD from a large pathology registry. Methods Cases were examined macroscopically and microscopically by two expert cardiac pathologists. Criteria used are presented in figure 1. Results The hearts from 7214 SCD cases were examined between 1994-2021. Sudden arrhythmic death syndrome (SADS), a morphologically normal heart, which can be underlain by the channelopathies, is most common (3821, 53%) followed by the cardiomyopathies (1558, 22%), then IHD (670, 9%). Valve disease (225, 3%), congenital heart disease (213, 3%) and myocarditis/sarcoidosis (206, 3%) are the next most common. Hypertensive heart disease (185, 3%), aortic disease (129, 2%), vascular disease (97, 1%) and conduction disease (40, 1%) are smaller proportions (figure 2). Discussion This is the largest SCD cohort with autopsy findings ever reported from one country. SADS and cardiomyopathies predominate. This study highlights the importance of the autopsy in SCD which is a significant public health concern in all age groups. Knowing the true incidence in our population will improve risk stratification and develop preventative strategies for family members. There is now a national pilot study integrating molecular autopsy into the assessment of SCD victims.