Sudden Cardiac Death Among Adolescents in the United Kingdom

BACKGROUND Causes and precipitating factors of sudden cardiac death (SCD) in adolescents are poorly understood.OBJECTIVES The authors sought to investigate the etiologies of SCD and their association with physical activity in a large cohort of adolescents.METHODS Between 1994 and June 2022, 7,675 cases of SCD were consecutively referred to our national cardiac pathology center; 756 (10%) were adolescents. All cases underwent detailed autopsy evaluation by expert cardiac pathologists. Clinical information was obtained from referring coroners.RESULTS A structurally normal heart, indicative of sudden arrhythmic death syndrome was the most common autopsy finding (n = 474; 63%). Myocardial diseases were detected in 163 cases (22%), including arrhythmogenic car-diomyopathy (n = 36; 5%), hypertrophic cardiomyopathy (n = 31; 4%), idiopathic left ventricular hypertrophy (n = 31; 4%), and myocarditis (n = 30; 4%). Coronary artery anomalies were identified in 17 cases (2%). Decedents were competitive athletes in 128 cases (17%), and 159 decedents (21%) died during exercise. Arrhythmogenic cardiomyopathy was diagnosed in 8% of athletes compared with 4% of nonathletes (P = 0.05); coronary artery anomalies were signifi-cantly more common in athletes (9% vs 1%; P < 0.001), as well as commotio cordis (5% compared with 1% in nonathletes; P = 0.001). The 3 main comorbidities were asthma (n = 58; 8%), epilepsy (n = 44; 6%), and obesity (n = 40; 5%).CONCLUSIONS Sudden arrhythmic death syndrome and myocardial diseases are the most common condi-tions diagnosed at autopsy in adolescent victims of SCD. Among causes of SCD, arrhythmogenic cardiomyopathy, cor-onary artery anomalies, and commotio cordis are more common in young athletes than in similar age sedentary individuals. (J Am Coll Cardiol 2023;81:1007-1017) (c) 2023 by the American College of Cardiology Foundation.