Triggers of Sudden Cardiac Arrest in Youth

Abstract

Background Exercise is considered a primary trigger for sudden cardiac arrest (SCA) in youth. We hypothesized that other factors have important associations. Methods During 2011–2012 and 2019–2020, we surveyed Parent Heart Watch members with children who had experienced sudden cardiac arrest or sudden cardiac death for 1) demographics; 2) pre-sudden cardiac arrest symptoms, evaluation, diagnoses; 3) family history; 4) medications, substances; 5) activity; 6) circumstances; and 7) post-sudden cardiac arrest diagnoses. Results 82 responses (~ 60% of members), 23.2% with surviving children. Mean age sudden cardiac arrest, 17.2 (4.5) years, median, 16 years; range, 5–30 years; male, 75%. Race/ethnicity: white, 81.0%; Black, 3.8%; Hispanic, 5.1%; Native American, 2.5%; >1 race, 7.6%. Family history of sudden cardiac arrest < 50 years, 17.1%. Prior cardiovascular symptoms: exercise fatigue, 30.8%; chest pain, 60.3%; palpitations, 16.7%; ≥1fainting episode, 19.2%; shortness of breath, 19.2%; upset, 9.0%. Prior (10.5%) and post (63.2%) cardiac diagnoses; activity-related, 60.5%; recent flu-like illness, 25.0%. Medications/substances including caffeine, energy drinks, alcohol and tobacco consumed prior to arrest, 57.9%. Arrest witnessed, 72.4%; fifteen events in location with an automated external defibrillator (AED) - survival, 47% when AED present. Conclusions Symptoms of sudden cardiac arrest are common but often ignored and not medically evaluated or treated. While activity was frequently associated with SCA, other important triggers of SCA appear to be medications and substances, often in the presence of underlying and frequently undiagnosed heart conditions, present in over half of cases. Potential triggers of sudden cardiac arrest include activity, medications and substances, and intercurrent illnesses.