[Primary electrical heart disease in adulthood--electrophysiological findings and therapy]

Sudden unexpected cardiac death and postmortem identification of a novel RYR2 gene mutation

A 13-year-old female was found lifeless at home. The autopsy and consecutive histological and toxicological examinations showed blood-rich and edematous lungs and foamy bloody content in the airways. No morphologic pathological findings were seen, especially no bleeding sources. Toxicological findings were unremarkable. The specific cause of death remained unclear. Due to reported losses of consciousness, a moleculargenetic postmortem testing was performed. A so far undescribed mutation in the cardiac ryanodine receptor gene RyR2 was detected. This mutation is suitable to explain the case history as well as the morphological findings. The cardiac ryanodine receptor gene RyR2 encodes the ryanodine receptor type 2, an ion channel in the cardiomyocytes. The ion channel regulates the influx of calcium ions and thus influences myocardial activity. Mutations in this channel may result in the catecholaminergic polymorphic ventricular tachycardia (CPVT), a cardiac arrhythmia that can lead to syncope and sudden cardiac death. This case demonstrates the usefulness and need of molecular autopsy, in particular to identify and treat possibly affected family members.

[Worldwide experience with automated external defibrillators: What have we achieved? What else can we expect?]

INTRODUCTION

In Germany approximately 70,000-100,000 SCD patients die from sudden cardiac death (SCD). SCD is not caused by a single factor but is a multifactorial problem. In 50 % of SCD victims, sudden cardiac death is the first manifestation of heart disease. SCD is caused by ventricular tachyarrhythmias in approximately 90 % of patients, whereas SCD is caused by bradyarrhythmias in 5-10 % of the patients.

METHODS

Risk stratification is not possible in the majority of them prior to the fatal event. Early defibrillation is the method of choice to terminate ventricular fibrillation. Therefore, it is mandatory to install automatic external defibrillators (AED) in places with many people. There is general agreement that early defibrillation with automated external defibrillators (AED) is an effective tool to treat patients with ventricular fibrillation and will improve survival.

CONCLUSION

It seems necessary to teach cardiocompression and AED use, also to children and adolescents. AED therapy "at home" did not improve survival in patients with cardiac arrest and can not be recommended.

[Sudden cardiac death and automated external defibrillators. Where we are in 2012?]

Sudden cardiac death (SCD) is one of the major problems in the western world with approximately 70.000-100.000 SCD patients (pts) in Germany and 450.000 SCD victims in the US. SCD is not caused by a single factor but is a multifactorial problem. SCD is caused by ventricular tachyarrhythmias in approximately 90% of pts, whereas SCD is caused by bradyarrhythmias in 5-10%. In 50% of SCD victims, sudden cardiac death is the first manifestation of a heart disease. There is general agreement that early defibrillation with automated external defibrillators (AED) is an effective tool to treat pts with ventricular fibrillation. Nevertheless, further stragies on cardiopulmonary resuscitation and AED therapy are necessary to improve survival of patients with cardiac arrest.