Sudden cardiac death in children and adolescents between 1 and 19 years of age.
BACKGROUND
Understanding pediatric sudden cardiac death (SCD) may inform age-specific prevention strategies.


OBJECTIVE
To characterize potential underlying causes of SCD in children and adolescents


METHODS
We performed a retrospective population-based study in Ontario, Canada, of all SCD cases in a 5-year period (2005-2009) involving persons aged 1-19 years identified from the comprehensive database of the Office of the Chief Coroner. Of 1204 coroner's cases, 351 potential SCD cases were reviewed.


RESULTS
Of 116 cases of adjudicated SCD, there was no identifiable cause of death in 60 (52%). The majority were males (66%), and median age was 12.7 years. The incidence of SCD was greatest between 1 and 2 years (3.14 per 100,000 person-years), decreased, and then increased to 1.01 per 100,000 person-years (15-19 years). Autopsy findings were normal in 29 of 35 (83%) of children younger than 5 years and were more likely to be abnormal in those 10 years and older (odds ratio 9.0; 95% confidence interval 3.3-24.9). In 9%, the pathology findings may be of uncertain significance. Most events occurred in the home (68%). Activity level at the time of the event was associated with both age group (χ(2) = 34.9; P < .001) and autopsy findings (χ(2) = 28.9; P < .001). Events during moderate or vigorous activity were more common in those older than 10 years 16 of 66 (24%), and the majority had abnormal autopsy findings 13 of 18 (72%).


CONCLUSIONS
Death in the very young is often caused by presumed primary arrhythmia syndromes, and death during exertion is typically seen in those with structural heart disease.


CONCLUSIONS
These differences should inform age-specific diagnostic and prevention strategies.
Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada.
Caileigh M
CM
Pilmer
The Labatt Family Heart Center and Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Joel A
JA
Kirsh
University of British Columbia, Vancouver, British Columbia, Canada.
Doris
D
Hildebrandt
Office of the Chief Coroner, Toronto, Ontario, Canada.
Andrew D
AD
Krahn
Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: rgow@cheo.on.ca.
Robert M
RM
Gow
D000293:Adolescent; D001145:Arrhythmias, Cardiac / Q000401:mortality; D001344:Autopsy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009043:Motor Activity; D012189:Retrospective Studies; D055815:Young Adult
ADL; ARVC; CI; CPVT; Death (sudden); ECG; Epidemiology; HCM; IQR; LQTS; MET; OCCO; OR; Office of the Chief Coroner of Ontario; Pediatrics; SCD; SHD; SNH/PAS; SUD; activity of daily living; arrhythmogenic right ventricular cardiomyopathy; catecholaminergic polymorphic ventricular tachycardia; confidence interval; electrocardiogram/electrocardiography; hypertrophic cardiomyopathy; interquartile range; long QT syndrome; metabolic equivalent; odds ratio; structural heart disease; structurally normal heart/presumed primary arrhythmia syndrome; sudden cardiac death; sudden unexpected death