Case series of sudden cardiac death

Objective: The objective of this study was to establish whether Sudden Cardiac Death (SCD) victims could have been identified prior to their event and potentially considered for an implantable cardioverter defibrillator (ICD) on the basis of previous cardiac history recorded within healthcare records. Methods: A case series of SCD in the UK (Southampton). Consecutive cases of adult SCDs presumed to be primarily caused by a ventricular arrhythmia as determined by an experienced pathologist with special interest in heart disease were identified over a 12-month period. SCD cases with clear evidence of acute myocardial infarction or coronary thrombosis were excluded from this study. Data were extracted from pathology and police reports. Hospital and GP notes provided information on previous symptoms, investigations and cardiac disease history. Two experts (Consultant Cardiologists, Electrophysiologists) judged the appropriateness of each case against pre-defined criteria. Results: 975 Coroner’s post-mortems were undertaken, 366 of these cases were SCDs (38%). There was no clinical/pathological evidence of an acute myocardial infarction or thrombus in 232 of these cases (63% of all SCDs). Two hundred and fifteen of these cases lived within the catchment area and were included in this study. Sixty-four percent of cases were male and median age was 75 years. Thirty-seven percent of events were witnessed. Agreement between experts on appropriateness for an ICD was very good (kappa score of 0.64). One case ( Conclusion: Two fifths of SCD victims had no recorded health service contact in relation to cardiac abnormalities or possible arrhythmia symptoms within their lifetime. A large number of patients suffered previous cardiac events or symptoms suggestive of a ventricular arrhythmia but were not referred for further investigations.