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Kannankeril PJ, Shoemaker MB, Fountain D, Roden DM, Yandell M, Tristani-Firouzi M, Etheridge SP, Webster G, George AL, McNally EM, MacLeod H, Burns KM. Family Screening After Sudden Death in a Population-Based Study of Children. Pediatrics 2022; 149:185400. [PMID: 35284934 PMCID: PMC9153292 DOI: 10.1542/peds.2021-054432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/24/2022] Open
Abstract
In a US population-based registry of sudden death in the young, this study performed familial evaluation of surviving relatives.
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Affiliation(s)
- Prince J. Kannankeril
- Departments of Pediatrics,Address correspondence to Prince J. Kannankeril, MD, MSCI,
Professor of Pediatrics, Children’s Hospital at Vanderbilt, 2200
Children’s Way, Suite 5230, Nashville, TN 37232-9119, E-mail:
| | - M. Ben Shoemaker
- Medicine, Vanderbilt University Medical Center,
Nashville, Tennessee
| | | | - Dan M. Roden
- Medicine, Vanderbilt University Medical Center,
Nashville, Tennessee
| | - Mark Yandell
- Department of Human Genetics, Utah Center for Genetic
Discovery
| | | | - Susan P. Etheridge
- Division of Pediatric Cardiology, University of Utah,
Salt Lake City, Utah
| | - Gregory Webster
- Division of Cardiology, Ann & Robert H. Lurie
Children’s Hospital of Chicago
| | | | - Elizabeth M. McNally
- Center for Genetic Medicine, Northwestern University
Feinberg School of Medicine, Chicago, Illinois
| | - Heather MacLeod
- Data Coordinating Center for the Sudden Death in the
Young Case Registry, Michigan Public Health Institute, Okemos, Michigan
| | - Kristin M. Burns
- Division of Cardiovascular Sciences, National Heart,
Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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2
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Viljoen R, Reid KM, Mole CG, Rangwaga M, Heathfield LJ. Towards molecular autopsies: Development of a FFPE tissue DNA extraction workflow. Sci Justice 2022; 62:137-144. [DOI: 10.1016/j.scijus.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 08/02/2021] [Accepted: 12/20/2021] [Indexed: 11/17/2022]
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3
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Szeligowski T. At the limits of patient autonomy: an ethical re-evaluation of coroner's postmortems. JOURNAL OF MEDICAL ETHICS 2021; 47:medethics-2020-106921. [PMID: 33504628 DOI: 10.1136/medethics-2020-106921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 06/12/2023]
Abstract
Patient autonomy is one of the four pillars of modern medical ethics. In some cases, however, its value is not absolute and autonomy may be overridden by sufficiently important matters of public interest. Coroner's autopsies represent an example of when the wishes of the deceased and their family may come in conflict with the benefits of knowledge gained from understanding the cause of death. Current legislation governing coroner's autopsies relies on the assumption of their obvious public benefit, hence consent for them need not be sought. This interpretation has attracted controversy, as exemplified by the case of Rotsztein vs HM Senior Coroner and a recent study questioning the prevalent use of invasive autopsy. However, this issue has received little recent attention in ethical literature. In this essay, the ethical nature of coroner's autopsies in cases of natural deaths with unexplained causes is examined as a balance between patient autonomy and the value of knowledge gained from them. This is done by analysing a case which under current legislation warrants coroner's autopsy, however, its ethical justification remains contentious. This discussion is expanded by discussion of non-invasive alternatives and comparison to another situation which balances individual autonomy with public benefits-organ donation. The conclusion of this analysis is a moral middle ground in which objection to invasive autopsy could be respected once issues of overriding public interest are excluded, or at least non-invasive alternatives should be considered, with coroners left responsible for demonstrating specific public needs that could override objection.
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4
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Ibrahim MS, Samuel B, Mohamed W, Suchdev K. Cardiac Dysfunction in Neurocritical Care: An Autonomic Perspective. Neurocrit Care 2020; 30:508-521. [PMID: 30484009 DOI: 10.1007/s12028-018-0636-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A number of neurologic disorders can cause cardiac dysfunction by involving the conductive system and contractile apparatus of the heart. This is especially prominent in the neurocritical care setting where the spectrum of cardiac dysfunction due to acute neurologic injury ranges from trivial and isolated electrocardiographic changes to malignant arrhythmias and sudden death (Table 1). The mechanism of these cardiac complications is complex and not fully understood. An understanding of the neuroanatomical structures and pathways is of immense importance to comprehend the underlying pathophysiology that culminates as cardiac damage and dysregulation. Once the process is initiated, it can complicate and adversely affect the outcome of primary neurologic conditions commonly seen in the neurocritical care setting. Not only are these cardiac disorders under-recognized, there is a paucity of data to formulate evidence-based guidelines regarding early detection, acute management, and preventive strategies. However, certain details of clinical features and their course combined with location of primary neurologic lesion on neuroimaging and data obtained from laboratory investigations can be of great value to develop a strategy to appropriately manage these patients and to prevent adverse outcome from these cardiac complications. In this review, we highlight the mechanisms of cardiac dysfunction due to catastrophic neurologic conditions or due to stress of critical illness. We also address various clinical syndromes of cardiac dysfunction that occur as a result of the neurologic illness and in turn may complicate the course of the primary neurologic condition.
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Affiliation(s)
- Mohammad S Ibrahim
- Department of Neurology, Division of Neurocritical care, Wayne State University School of Medicine, Detroit, MI, USA
| | - Bennson Samuel
- Department of Neurology, Division of Neurocritical care, Wayne State University School of Medicine, Detroit, MI, USA
| | - Wazim Mohamed
- Department of Neurology, Division of Neurocritical care, Wayne State University School of Medicine, Detroit, MI, USA
| | - Kushak Suchdev
- Department of Neurology, Division of Neurocritical care, Wayne State University School of Medicine, Detroit, MI, USA.
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5
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D'Arcy C, Hazrati LN, Chiasson DA. Histopathologic Analysis in Sudden Infant and Child Deaths: A Practical Approach. Acad Forensic Pathol 2018; 8:492-538. [PMID: 31240057 DOI: 10.1177/1925362118797727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/02/2018] [Indexed: 12/20/2022]
Abstract
The forensic pathologist responsible for sudden unexpected death (SUD) investigation in the pediatric setting faces many challenges. It usually takes many years to obtain reasonable experience and exposure to the wide variety of diseases that may present as SUD in a pediatric context, and to appreciate the differences in the etiology and clinical context between the pediatric and adult SUD setting. In pediatric SUD, it is necessary to conduct a systematic, pediatric-focused autopsy investigation including extensive histopathological assessment and ancillary testing. Postmortem histologic findings in the context of SUD in the pediatric population are often subtle and distinctly different from those seen in the adult population. The pathologist must have an understanding of both developmental and pathological processes in order to correctly interpret the findings during a pediatric autopsy. A system-based, histopathology-focused review of common entities, normal variants, and incidental findings that can prove challenging will be discussed. For the forensic pathologist tasked with pediatric SUD autopsies, development of a strong collaborative relationship with a pediatric pathologist and/or neuropathologist to assist with histopathological analysis is strongly endorsed.
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6
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Brugada J, Keegan R. Asymptomatic Ventricular Pre-excitation: Between Sudden Cardiac Death and Catheter Ablation. Arrhythm Electrophysiol Rev 2018; 7:32-38. [PMID: 29636970 DOI: 10.15420/aer.2017.51.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Debate about the best clinical approach to the management of asymptomatic patients with ventricular pre-excitation and advice on whether or not to invasively stratify and ablate is on-going. Weak evidence about the real risk of sudden cardiac death and the potential benefit of catheter ablation has probably prevented the clarification of action in this not infrequent and sometimes conflicting clinical situation. After analysing all available data, real evidence-based medicine could be the alternative strategy for managing this group of patients. According to recent surveys, most electrophysiologists invasively stratify. Based on all accepted risk factors - younger age, male, associated structural heart disease, posteroseptal localisation, ability of the accessory pathway to conduct anterogradely at short intervals of ≤250 milliseconds and inducibility of sustained atrioventricular re-entrant tachycardia and/or atrial fibrillation - a shared decisionmaking process on catheter ablation is proposed.
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Affiliation(s)
- Josep Brugada
- Cardiovascular Institute, Hospital Clinic and Paediatric Arrhythmia Unit, Hospital Sant Joan de Déu, University of BarcelonaBarcelona, Spain
| | - Roberto Keegan
- Electrophysiology Service, Private Hospital of the SouthBahia Blanca, Argentina
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7
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Roston TM, Dewar L, Franciosi S, Hathaway J, Bartels K, Cunningham T, Gibbs KA, Sheps S, Laksman ZWM, Sanatani S, Krahn AD. The accessibility and utilization of genetic testing for inherited heart rhythm disorders: a Canadian cross-sectional survey study. J Community Genet 2017; 9:257-262. [PMID: 29170972 DOI: 10.1007/s12687-017-0348-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/08/2017] [Indexed: 01/01/2023] Open
Abstract
The genetic basis of many sudden death-related conditions has been elucidated. These include inherited arrhythmias and arrhythmogenic cardiomyopathies, termed inherited heart rhythm disorders (IHRD). Advising on and interpreting genetic testing is challenging for the general cardiologist. This has led to the development of interdisciplinary clinics for IHRD in varying stages of establishment in Canada. We sought the viewpoints and patterns of practice of Canadian IHRD experts, and assessed their ability to access genetic testing for IHRD using a national cross-sectional survey. Of 56 participants, most were physicians (68%) or genetic counselors (19%). Despite working collaboratively, most genetic counselors (59%) were either not satisfied or only somewhat satisfied with their relationships with physicians. Ninety percent of participants were involved in offering genetic evaluation, including 80% who felt that testing was usually/always accessible. Most offered genetic testing to confirm clinical diagnosis and/or direct family screening. Post-mortem genetic analysis was sought by 69% of respondents; however, a lack of retained tissue and/or poor tissue preparation hindered this process. Family screening was usually recommended in the setting of a pathogenic/likely pathogenic variant. The most commonly perceived barrier to genetic testing was cost to the healthcare system. More than a quarter of patients waited ≥ 6 months for funding. An ability to engage at-risk relatives was rated as limited/poor by 34% of participants. Despite the establishment of several interdisciplinary clinics, timely access to affordable testing, supported by strong team communication, continues to be a barrier to genetic testing in Canada.
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Affiliation(s)
- Thomas M Roston
- BC Inherited Arrhythmia Program, Vancouver, BC, Canada.,Heart Rhythm Vancouver, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada.,University of Alberta, Edmonton, AB, Canada
| | - Laura Dewar
- Simon Fraser University, Burnaby, BC, Canada
| | - Sonia Franciosi
- Children's Heart Centre, BC Children's Hospital, Vancouver, BC, Canada
| | | | | | - Taylor Cunningham
- Children's Heart Centre, BC Children's Hospital, Vancouver, BC, Canada
| | - Karen A Gibbs
- BC Inherited Arrhythmia Program, Vancouver, BC, Canada
| | - Sam Sheps
- University of British Columbia, Vancouver, BC, Canada
| | - Zachary W M Laksman
- BC Inherited Arrhythmia Program, Vancouver, BC, Canada.,Heart Rhythm Vancouver, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Shubhayan Sanatani
- BC Inherited Arrhythmia Program, Vancouver, BC, Canada.,Heart Rhythm Vancouver, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada.,Children's Heart Centre, BC Children's Hospital, Vancouver, BC, Canada
| | - Andrew D Krahn
- BC Inherited Arrhythmia Program, Vancouver, BC, Canada. .,Heart Rhythm Vancouver, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada. .,Heart Rhythm Vancouver, 211-1033 Davie St, Vancouver, BC, V6E 1M7, Canada.
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8
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Schlitt A, Hantke F, Kuss O. [Impact of national cardiac, cardiac surgery, and intensive care conferences on cardiovascular mortality in Germany]. Med Klin Intensivmed Notfmed 2017; 114:30-37. [PMID: 29085984 DOI: 10.1007/s00063-017-0368-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 08/20/2017] [Accepted: 08/22/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Thousands of physicians and other employees of the health system participate in major national congresses of German cardiologists, cardiac surgeons, and intensive care physicians and are, thus, key players in the treatment of acute cardiovascular events. While differences in mortality during such congress days were described in the USA, Germany-wide data are missing. METHODS In order to study the effect of congresses on cardiovascular mortality, the numbers of daily cardiovascular deaths (ICD-10 codes: I01-I15, I20-I25, I30-I52) in Germany from 1997-2011 from the data of the Federal Statistical Office were used for the most important cardiac, intensive medical, and cardiac surgery congresses (DGAI, DGIIN, DGK, DGTHG, DIVI). For comparison, numbers of cardiovascular deaths at a defined time interval before and after the respective Congress were defined. RESULTS Over the 15-year study period, a total of 701,272 cardiovascular deaths (conference days: 233,456, nonconference days: 467,816) were observed during 89 conferences with 318 congress days and 638 control days. The relative risks of increased mortality on congresses were inconspicuous for the entire population (relative risk [RR] 0.998, confidence interval [CI] 0.994; 1.004), even after adjustment for gender, age group, professional, and ICD codes (RR 1.005, CI 0.951; 1.063). CONCLUSION National congresses of cardiologists, intensive care physicians and cardiac surgeons have no influence on the cardiovascular mortality in Germany.
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Affiliation(s)
- A Schlitt
- Paracelsus-Harz-Klinik Bad Suderode, Quedlinburg und Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Paracelsusstr. 1, 06485, Quedlinburg, Deutschland.
| | - F Hantke
- Praxis Bündnerhof Basel, Basel, Schweiz
| | - O Kuss
- Centre for Health and Society and Institute of Medical Statistics, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland.,Institut für Biometrie und Epidemiologie, Deutsches Diabetes-Zentrum (DDZ) und Leibniz-Zentrum für Diabetes-Forschung, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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9
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Wang C, Duan S, Lv G, Lai X, Chen R, Lin H, Qiu S, Tang J, Kuang W, Xu C. Using whole exome sequencing and bioformatics in the molecular autopsy of a sudden unexplained death syndrome (SUDS) case. Forensic Sci Int 2015; 257:e20-e25. [PMID: 26385840 DOI: 10.1016/j.forsciint.2015.08.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/27/2015] [Accepted: 08/28/2015] [Indexed: 01/09/2023]
Abstract
Whole exome sequencing (WES) and bioinformatics analysis were used to investigate potential disease-causing gene mutations in a sudden unexplained death syndrome (SUDS) case after autopsy and pathology tests failed to suggest an obvious disease mechanism. Following whole exome sequencing, a 3-step bioinformatics filtering procedure was carried out to identify possible pathogenic genomic features. Single nucleotide variations (SNVs) were analyzed and ranked by likely mutation impact using various open online tools. After screening, we identified G643S as a putative causative heterozygous mutation in the KCNQ1 gene. This mutation has been reported in abnormalities consistent with SUDS, such as IKs in cardiac myocytes, a condition that predisposes for arrhythmias. Our work demonstrates the application of sequencing technology at the whole exome level for determining potential causes of an otherwise unexplained death.
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Affiliation(s)
- Chun Wang
- Chengdu Sport University, Chengdu, Sichuan 610041, PR China
| | - Shan Duan
- Shenzhen Research Institute of Population and Family Planning, Shenzhen, Guangdong 518040, PR China
| | - Guoli Lv
- Guangzhou institute of Forensic Science, Guangzhou, Guangdong 510030, PR China
| | - Xiaoping Lai
- Guangdong Medical College, Dongguan, Guangdong 523808, PR China
| | - Rui Chen
- Guangdong Medical College, Dongguan, Guangdong 523808, PR China
| | - Hanguang Lin
- Guangdong Medical College, Dongguan, Guangdong 523808, PR China
| | - Shengyuan Qiu
- Guangdong Medical College, Dongguan, Guangdong 523808, PR China
| | - Jianpin Tang
- Guangdong Medical College, Dongguan, Guangdong 523808, PR China
| | - Wenjian Kuang
- Guangdong Medical College, Dongguan, Guangdong 523808, PR China
| | - Chuanchao Xu
- Guangdong Medical College, Dongguan, Guangdong 523808, PR China.
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10
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Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Europace 2015; 17:1601-87. [PMID: 26318695 DOI: 10.1093/europace/euv319] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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11
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Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2015; 36:2793-2867. [PMID: 26320108 DOI: 10.1093/eurheartj/ehv316] [Citation(s) in RCA: 2530] [Impact Index Per Article: 281.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
MESH Headings
- Acute Disease
- Aged
- Anti-Arrhythmia Agents/therapeutic use
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/therapy
- Autopsy/methods
- Cardiac Resynchronization Therapy/methods
- Cardiomyopathies/complications
- Cardiomyopathies/therapy
- Cardiotonic Agents/therapeutic use
- Catheter Ablation/methods
- Child
- Coronary Artery Disease/complications
- Coronary Artery Disease/therapy
- Death, Sudden, Cardiac/prevention & control
- Defibrillators
- Drug Therapy, Combination
- Early Diagnosis
- Emergency Treatment/methods
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/therapy
- Heart Transplantation/methods
- Heart Valve Diseases/complications
- Heart Valve Diseases/therapy
- Humans
- Mental Disorders/complications
- Myocardial Infarction/complications
- Myocardial Infarction/therapy
- Myocarditis/complications
- Myocarditis/therapy
- Nervous System Diseases/complications
- Nervous System Diseases/therapy
- Out-of-Hospital Cardiac Arrest/therapy
- Pregnancy
- Pregnancy Complications, Cardiovascular/therapy
- Primary Prevention/methods
- Quality of Life
- Risk Assessment
- Sleep Apnea, Obstructive/complications
- Sleep Apnea, Obstructive/therapy
- Sports/physiology
- Stroke Volume/physiology
- Terminal Care/methods
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/therapy
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Electrophysiology testing and catheter ablation are helpful when evaluating asymptomatic patients with Wolff-Parkinson-White pattern: the con perspective. Card Electrophysiol Clin 2015; 7:377-83. [PMID: 26304516 DOI: 10.1016/j.ccep.2015.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The association between asymptomatic Wolff-Parkinson-White (WPW) syndrome and sudden cardiac death (SCD) has been well documented. The inherent properties of the accessory pathway determine the risk of SCD in WPW, and catheter ablation essentially eliminates this risk. An approach to WPW syndrome is needed that incorporates the patient's individualized considerations into the decision making. Patients must understand that there is a trade-off of a small immediate risk of an invasive approach for elimination of a small lifetime risk of the natural history of asymptomatic WPW. Clinicians can minimize the invasive risk by only performing ablation for patients with at-risk pathways.
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13
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Mazzanti A, O'Rourke S, Ng K, Miceli C, Borio G, Curcio A, Esposito F, Napolitano C, Priori SG. The usual suspects in sudden cardiac death of the young: a focus on inherited arrhythmogenic diseases. Expert Rev Cardiovasc Ther 2014; 12:499-519. [PMID: 24650315 DOI: 10.1586/14779072.2014.894884] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Up to 14,500 young individuals die suddenly every year in Europe of cardiac pathologies. The majority of these tragic events are related to a group of genetic defects that predispose the development of malignant arrhythmias (inherited arrhythmogenic diseases [IADs]). IADs include both cardiomyopathies (hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, dilated cardiomyopathy) and channelopathies (long QT syndrome, short QT syndrome, Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia). Every time an IAD is identified in a patient, other individuals in his/her family may be at risk of cardiac events. However; if a timely diagnosis is made, simple preventative measures may be applied. Genetic studies play a pivotal role in the diagnosis of IADs and may help in the management of patients and their relatives.
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Affiliation(s)
- Andrea Mazzanti
- Molecular Cardiology, IRCCS Salvatore Maugeri Foundation, Pavia, Italy
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14
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Niiyama M, Tanaka F, Nakajima S, Itoh T, Matsumoto T, Kawakami M, Naganuma Y, Omama S, Komatsu T, Onoda T, Sakata K, Ichikawa T, Nakamura M. Population-based incidence of sudden cardiac and unexpected death before and after the 2011 earthquake and tsunami in Iwate, northeast Japan. J Am Heart Assoc 2014; 3:e000798. [PMID: 24811614 PMCID: PMC4309070 DOI: 10.1161/jaha.114.000798] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the temporal impact of the 2011 Japan earthquake and tsunami on the incidence of sudden cardiac and unexpected death (SCUD). METHODS AND RESULTS We surveyed the impact of the disaster on the incidence and clinical characteristics of SCUD in Iwate. To perform complete identification of SCUD for 8 weeks before and 40 weeks after the disaster, medical records and death certificates relevant to SCUD were surveyed in the study area. Compared with the previous year's rate, the incidence (per 10 000 person-year) of SCUD for the initial 4 weeks after the disaster (acute phase) was double (33.5 vs 18.9), and thereafter the rate returned to the previous level. Significant relationships were found between weekly numbers of SCUD and seismic activity (intensity, r=0.43; P<0.005: frequency, r=0.46; P<0.002). The standardized incidence ratio (SIR) of SCUD in the acute phase was significantly increased compared with that of previous years (1.71, 95% CI 1.33 to 2.16). Increased SIRs were predominantly found in female subjects (1.73, 95% CI 1.22 to 2.37), the elderly (1.73, 95% CI 1.29 to 2.27), and residents living in the tsunami-stricken area (1.83, 95% CI 1.33 to 2.46). In addition, SIRs for weekdays (1.71, 95% CI 1.28 to 2.24) and nights-mornings (2.09, 95% CI 1.48 to 2.86) were amplified. CONCLUSIONS The present results suggest that the magnitude of a disaster, related stress, and population aging may cause a temporary increase in the incidence of SCUD with amplification of ordinary weekly and circadian variations.
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Affiliation(s)
- Masanobu Niiyama
- Department of Internal Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan
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15
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Roston TM, De Souza AM, Sandor GGS, Sanatani S, Potts JE. Physical activity recommendations for patients with electrophysiologic and structural congenital heart disease: a survey of Canadian health care providers. Pediatr Cardiol 2013; 34:1374-81. [PMID: 23435716 DOI: 10.1007/s00246-013-0654-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 02/06/2013] [Indexed: 01/15/2023]
Abstract
Determining safe levels of physical activity for children and adolescents with electrophysiologic and structural congenital heart disease is a challenging clinical problem. The body of evidence for making these recommendations is limited and likely based on expert opinion, medicolegal concerns, and perceived risks of sudden cardiac death (SCD) with activity. The Bethesda Conference has established consensus guidelines for determining the eligibility of athletes with cardiovascular abnormalities for competitive sports and their disqualification from them. However, literature on guidelines for noncompetitive physical activity is not available. A survey was designed to determine practice patterns for patients with electrophysiologic and structural congenital heart disease. Between July 2011 and December 2011, approximately 350 health care providers working with this group of patients were recruited by email or while attending professional meetings. The survey received 81 responses, primarily from pediatric cardiologists (70 %). The findings indicate that the majority of Canadian cardiac care providers surveyed are only partially implementing current recommendations. Areas of variance included physical activity recommendations for hypertrophic cardiomyopathy, long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, and heart transplantation, among others. The development of comprehensive consensus guidelines for activity recommendations was supported by 96 % of the respondents. The heterogeneity of responses may be attributable to conflicting and poorly evidenced information in the literature, a lack of emphasis on recreational activity, an entrenched tendency toward bed rest in the cardiology community, and a lack of awareness by cardiac care providers regarding the actual risk associated with physical activity in electrophysiologic and structural congenital heart disease. A balanced discussion is required in considering both the significant benefit of physical activity in reducing cardiovascular risk factors and the small possibility of SCD in children and young adults with electrophysiologic and structural congenital heart disease.
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Affiliation(s)
- Thomas M Roston
- Children's Heart Centre, British Columbia Children's Hospital, University of British Columbia, 4480 Oak Street, 1F Clinic, Vancouver, BC, V6H 3V4, Canada
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16
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Wang YJ, Hu HH. Sudden death after medullary infarction - a case report. Kaohsiung J Med Sci 2013; 29:578-81. [PMID: 24099113 DOI: 10.1016/j.kjms.2013.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 07/27/2012] [Indexed: 11/28/2022] Open
Abstract
Sudden death in a stable medullary infarction case frequently induces legal problems. Currently, the etiology of the most reported cases are not known because autopsy is rare. Here, we report one female patient with medullary infarction who experienced a sudden cardiopulmonary arrest during a brain magnetic resonance imaging (MRI) study. The blood flow changes on the MRI indicated that her death resulted from the sudden collapse of systemic circulation. Dysautonomia, or sudden respiratory arrest resulting from brainstem dysfunction, was suspected. In this report, we present her cranial MRI findings and discuss the possible pathophysiology after reviewing the relevant literature. We also recommend certain tests for patients with medullary infarction to prevent the risk of sudden unexpected deaths.
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Affiliation(s)
- Yuh-Jen Wang
- Department of Neurology, Taipei City Hospital, Taipei, Taiwan; National Yang-Ming University, Taipei, Taiwan
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Pilmer CM, Porter B, Kirsh JA, Hicks AL, Gledhill N, Jamnik V, Faught BE, Hildebrandt D, McCartney N, Gow RM, Goodman J, Krahn AD. Scope and nature of sudden cardiac death before age 40 in Ontario: A report from the Cardiac Death Advisory Committee of the Office of the Chief Coroner. Heart Rhythm 2013; 10:517-23. [DOI: 10.1016/j.hrthm.2012.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Indexed: 10/27/2022]
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18
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The Year in Review of Clinical Cardiac Electrophysiology. J Am Coll Cardiol 2013; 61:772-82. [DOI: 10.1016/j.jacc.2012.09.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 08/24/2012] [Accepted: 09/25/2012] [Indexed: 11/23/2022]
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Huisma FF, Potts JE, Gibbs KA, Sanatani S. Assessing the knowledge of sudden unexpected death in the young among Canadian medical students and recent graduates: a cross-sectional study. BMJ Open 2012; 2:e001798. [PMID: 23242483 PMCID: PMC3533023 DOI: 10.1136/bmjopen-2012-001798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 08/04/2012] [Accepted: 11/22/2012] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To determine the level of knowledge concerning Sudden Unexpected Death in the Young (SUDY) among Canadian medical students and recent graduates (≤5 years after graduating). DESIGN A cross-sectional study was conducted by distributing a standardised, multiple choice, online questionnaire which assessed basic knowledge of SUDY. SETTING Canadian medical schools and residency training programmes. PARTICIPANTS 614 Canadian medical students (in either their penultimate or final year) and recent graduates (≤5 years after graduating) completed an anonymous online questionnaire. PRIMARY AND SECONDARY OUTCOME MEASURES The level of knowledge regarding molecular aetiology, clinical presentation, pharmacological management and modes of inheritance of six of the commonest conditions causing SUDY, including hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT syndrome (LQT) and Wolff-Parkinson White syndrome (WPW), were compared between medical students and recent graduates. Questions were broken down into basic knowledge and advanced categories and analysed as a secondary outcome measure. RESULTS Of 614 responses, approximately two-thirds were answered by recent graduates, who generally scored 10% higher on all subject categories than medical students. Overall, questions regarding HCM were best answered (40%), followed by WPW syndrome (32%), CPVT (30%), ARVC (23%), Brugada syndrome (21%) and LQT syndrome (17%). Questions categorised as basic knowledge were answered 30% and 39% correctly in medical student and recent graduate groups, respectively, and those in the advanced category were answered 20% and 25% correctly. CONCLUSIONS Survey respondents fared poorly when answering questions regarding SUDY, which may be a reflection of inadequate medical education regarding these disorders. Standardised teaching regarding SUDY needs to occupy a stronger focus in Canadian medical curricula in order to prevent more unnecessary deaths by these syndromes in the future.
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Affiliation(s)
- Felicity F Huisma
- Division of Pediatric Cardiology, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
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MAZZANTI ANDREA, PRIORI SILVIAG. Molecular Autopsy for Sudden Unexplained Death? Time to Discuss Pros and Cons. J Cardiovasc Electrophysiol 2012; 23:1099-102. [DOI: 10.1111/j.1540-8167.2012.02430.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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21
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Obeyesekere MN, Leong-Sit P, Krahn AD, Gula LJ, Yee R, Skanes AC, Klein GJ. Asymptomatic Wolff-Parkinson-White Syndrome: Who Should Be Treated? Card Electrophysiol Clin 2012; 4:273-280. [PMID: 26939946 DOI: 10.1016/j.ccep.2012.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article discusses the merits of electrophysiology study (EPS) and/or ablation for asymptomatic preexcitation Wolff-Parkinson-White (WPW) ECG pattern. Sudden deaths in asymptomatic patients are too few to merit broad screening and aggressive intervention. It also discusses the risks of ablation and the low predictive accuracy of EPS. When WPW is an incidental finding, the decision to proceed with investigation and ablation can be made considering patients' situations and preferences. An invasive strategy is targeted at patients concerned about the low risk of life-threatening arrhythmia as a first presentation after a discussion of the risks and benefits.
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Affiliation(s)
- Manoj N Obeyesekere
- Division of Cardiology, Western University, 339 Windermere Road, C6-110, London, Ontario N6A 5A5, Canada
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Obeyesekere MN, Leong-Sit P, Massel D, Manlucu J, Modi S, Krahn AD, Skanes AC, Yee R, Gula LJ, Klein GJ. Risk of Arrhythmia and Sudden Death in Patients With Asymptomatic Preexcitation. Circulation 2012; 125:2308-15. [DOI: 10.1161/circulationaha.111.055350] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The incidence of sudden cardiac death (SCD) and the management of this risk in patients with asymptomatic preexcitation remain controversial. The purpose of this meta-analysis was to define the incidence of SCD and supraventricular tachycardia in patients with asymptomatic Wolff-Parkinson-White ECG pattern.
Methods and Results—
We performed a systematic search of prospective, retrospective, randomized, or cohort English-language studies in EMBASE and Medline through February 2011. Studies reporting asymptomatic patients with preexcitation who did not undergo ablation were included. Twenty studies involving 1869 patients met our inclusion criteria. Participants were primarily male with a mean age ranging from 7 to 43 years. Ten SCDs were reported involving 11 722 person-years of follow-up. Seven studies originated from Italy and reported 9 SCDs. The risk of SCD is estimated at 1.25 per 1000 person-years (95% confidence interval [CI], 0.57–2.19). A total of 156 supraventricular tachycardias were reported involving 9884 person-years from 18 studies. The risk of supraventricular tachycardia was 16 (95% CI, 10–24) events per 1000 person-years of follow-up. Children had numerically higher SCD (1.93 [95% CI, 0.57–4.1] versus 0.86 [95% CI, 0.28–1.75];
P
=0.07) and supraventricular tachycardia (20 [95% CI, 12–31] versus 14 [95% CI, 6–25];
P
=0.38) event rates compared with adults.
Conclusion—
The low incidence of SCD and low risk of supraventricular tachycardia argue against routine invasive management in most asymptomatic patients with the Wolff-Parkinson-White ECG pattern.
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Affiliation(s)
- Manoj N. Obeyesekere
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Peter Leong-Sit
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - David Massel
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Jaimie Manlucu
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Simon Modi
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Andrew D. Krahn
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Allan C. Skanes
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Raymond Yee
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Lorne J. Gula
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - George J. Klein
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
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Schrag B, Vaucher P, Bollmann MD, Mangin P. Death caused by cardioinhibitory reflex cardiac arrest—A systematic review of cases. Forensic Sci Int 2011; 207:77-83. [DOI: 10.1016/j.forsciint.2010.09.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 08/30/2010] [Accepted: 09/09/2010] [Indexed: 11/16/2022]
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Current World Literature. Curr Opin Cardiol 2011; 26:71-8. [DOI: 10.1097/hco.0b013e32834294db] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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