8:40 AM - 10:40 AM
[AJS-02] Screening for sudden cardiac death in the young: Useful tool or wishful thinking
Sudden cardiac death (SCD) in the young is a rare event. It occurs in 1.1/100 000 person-years between 1 – 18 years of age and 2.8/100 000 in a population <35 years of age. Main causes include cardiomyopathy, myocarditis, thoracic dissection and ischemic heart disease on one side and sudden unexplained cardiac death on the other. The latter is responsible for ~40 % of suddenly died young persons and includes inherited primary arrhythmia syndromes. Frequency of SCD in the young is far behind motor accidents, injuries and even lightening strike or avalanche fatalities. It is genetically determined in the majority with prevailing autosomal dominant heredity. A lot of effort has been put into potential screening strategies for the risk of SCD including history, physical examination and 12-lead electrocardiogram. Convincing data supporting the usefulness of such effort is so far lacking. The reasons lie in the nature of the 12-lead ECG being used as the principle screening test on one side and in missing data showing clear morbidity/mortality benefit on the other. False positive screening results may be as high as 10 % resulting in major psychological burden for young persons involved and generating significant further costs of the diagnostic work-up. Thus a population covering ECG screening is so far not uniformly recommended and further data need to be generated from studies involving specific populations or areas. Alternative preventive strategies include family screening in probands with SCD or detected malignant arrhythmias and improvements in the automatic external defibrillator availability.