Sudden arrhythmic death syndrome accounts for 22% of all sudden cardiac deaths in young people and presents with several identifiable warning signs before death, according to results of a retrospective observational study. The research was presented at the European Society of Cardiology's ESC Preventive Cardiology 2025 congress in Milan, Italy.
Researchers analyzed 903 cases of sudden cardiac death in patients aged 1 to 36 years from 2000 to 2010 and compared them with population-based controls. They found that 64% of sudden arrhythmic death syndrome (SADS) cases were in males with a median age of 23 years.
"SADS has not been well evaluated despite being one of the most common underlying causes of sudden cardiac death in young people, including young athletes," wrote Matilda Frisk Torell, MD, of the Sahlgrenska Academy, University of Gothenburg in Sweden, along with fellow researchers.
Among SADS cases, 4.2% had previously been hospitalized with syncope compared with 0.41% in controls, while hospitalization due to convulsions occurred in 3.5% of cases vs 0.14% in controls. Additionally, 11% of cases had known arrhythmic disease, and 18% showed pathological electrocardiogram findings. Pre-excitation was the most common abnormality.
The data also revealed that approximately half (52%) of patients who had SADS experienced symptoms including palpitations, syncope, nausea/vomiting, and signs related to infection. One noteworthy finding was that 17% of patients had a previous psychiatric diagnosis, and 11% had received psychotropic drugs.
"With increased knowledge of the signs and symptoms that may precede SADS, such as syncope, seizure-like episodes and pre-excitation, we may be able to identify young people at risk during health care visits," Dr. Torell stated. "Our results also highlight the need for further study of psychiatric disease/treatment as risk factors for SADS and the potential for gastrointestinal symptoms and infectious diseases to act as triggers in predisposed individuals."
The researchers found that 33% of SADS cases had a hospitalization or outpatient care visit within 180 days of death, compared with 24% of controls, which suggests potential opportunities for intervention during medical encounters.
Also, "preparticipation screening of young athletes is an important opportunity to identify these signs and reduce the occurrence of SADS, and yet current levels of screening are low," noted Dr. Torell.
The study was based on the SUDden cardiac Death in the Young (SUDDY) cohort from which investigators analyzed death certificates, autopsy reports, medical records, electrocardiograms, biological samples, and parental data.
The project received funding from multiple Swedish sources. Dr. Torell had no disclosures to report.
