Incidence, Causes, and Survival Trends From Cardiovascular-Related Sudden Cardiac Arrest in Children and Young Adults 0 to 35 Years of Age

Abstract

Background— Sudden cardiac arrest is a leading cause of death in children and young adults. This study determined the incidence, cause, and outcomes of cardiovascular-related out-of-hospital cardiac arrest (OHCA) in individuals <35 years of age. Methods and Results— A retrospective cohort of OHCA in children and young adults from 1980 through 2009 was identified from the King County (Washington) Division of Emergency Medical Services' Cardiac Arrest Database. Incidence was calculated from population census data and causes of arrest determined by review of autopsy reports and all available medical records. A total of 361 cases (26 cases 0–2 years of age, 30 cases 3–13 years of age, 60 cases 14–24 years of age, and 245 cases 25–35 years of age) of OHCA were treated by emergency medical services responders, for an overall incidence of 2.28 per 100 000 person-years (2.1 in those 0–2 years of age, 0.61 in those 3–13 years of age, 1.44 in those 14–24 years of age, and 4.40 in those 25–35 years of age). The most common causes of OHCA were congenital abnormalities in those 0 to 2 years of age (84.0%) and 3 to 13 years of age (21%), presumed primary arrhythmia in those 14 to 24 of age (23.5%), and coronary artery disease in those 25 to 35 years of age (42.9%). The overall survival rate was 26.9% (3.8% in those 0–2 years of age, 40.0% in those 3–13 years of age, 36.7% in those 14–24 years of age, and 27.8% in those 25–35 years of age). Survival increased throughout the study period from 13.0% in 1980 to 1989 to 40.2% in 2000 to 2009 ( P <0.001). Conclusions— The incidence of OHCA in children and young adults is higher than previously reported, and a more specific understanding of the causes should guide future prevention programs. Survival trends support contemporary resuscitation protocols for OHCA in the young.

A Clinical Perspective on Sudden Cardiac Death

“…10 The numbers are higher in the King County (Washington) Cardiac Arrest Database, being 2.1 for infants of 0-2 years, 0.61 for children aged 3-13 years, 1.44 for young people aged 14-24 years and 4.4 for 25-35-year-olds, respectively. 11 In the Oregon Sudden Unexpected Death Study, the annual incidence of sudden cardiac arrest among blacks was more than twofold higher than in whites for both men and women. 12 In Denmark, the annual incidence of SCD is 2.3 for people aged 1-35 years and 21.7 for people aged 36-49 years.…”

“…45,46 In the young (<35 years), the most common cause of SCD is arrhythmia, mostly in the context of an apparently normal heart. 11,47 The most common causes of SCD are congenital abnormalities in those aged 0-13 years, primary arrhythmia in the 14-24-year age group, and CAD in those >25 years. 11 In 5-20 % of cases no significant cardiac abnormality is found at autopsy.…”

“…11,47 The most common causes of SCD are congenital abnormalities in those aged 0-13 years, primary arrhythmia in the 14-24-year age group, and CAD in those >25 years. 11 In 5-20 % of cases no significant cardiac abnormality is found at autopsy. 10,47 In a recent Danish registry report on individuals aged <50 years, sudden death was caused by noncardiac diseases, such as pulmonary embolism, meningitis and cerebrovascular bleeding, in 28 % of cases.…”

When can ablation be considered a reasonable option in young asymptomatic patients with a Wolff–Parkinson–White ECG?

“…It is notable that most patients presenting with VF were probably symptomatic prior to VF (thus lending itself to earlier diagnosis and therapy). Also when VF occurs most are aborted (~60%) [2,4,5]. The low risk of death associated with asymptomatic WPW contrasts with the incidence of sudden death in population studies of 0.003-0.02 per 100 person-years in 0-49-year-olds [4,5].…”

“…Also when VF occurs most are aborted (~60%) [2,4,5]. The low risk of death associated with asymptomatic WPW contrasts with the incidence of sudden death in population studies of 0.003-0.02 per 100 person-years in 0-49-year-olds [4,5]. The lower background sudden death rate in the general population argue for attempts to identify at-risk asymptomatic WPW individuals.…”