title: Sudden cardiac death in forensic medicine – Swiss recommendations for a multidisciplinary approach.
abstract: Sudden cardiac death (SCD) is by definition unexpected and cardiac in nature. The investigation is almost invariably performed by a forensic pathologist. Under these circumstances the role of the forensic pathologist is twofold: (1.) to determine rapidly and efficiently the cause and manner of death and (2.) to initiate a multidisciplinary process in order to prevent further deaths in existing family members. If the death is determined to be due to "natural" causes the district attorney in charge often refuses further examinations. However, additional examinations, i.e. extensive histopathological investigations and/or molecular genetic analyses, are necessary in many cases to clarify the cause of death. The Swiss Society of Legal Medicine created a multidisciplinary working group together with clinical and molecular geneticists and cardiologists in the hope of harmonising the approach to investigate SCD. The aim of this paper is to close the gap between the Swiss recommendations for routine forensic post-mortem cardiac examination and clinical recommendations for genetic testing of inherited cardiac diseases; this is in order to optimise the diagnostic procedures and preventive measures for living family members. The key points of the recommendations are (1.) the forensic autopsy procedure for all SCD victims under 40 years of age, (2.) the collection and storage of adequate samples for genetic testing, (3.) communication with the families, and (4.) a multidisciplinary approach including cardiogenetic counselling.
authors.affiliation: Department of Cardiology, Inselspital, University Hospital Bern, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Wilhelm
authors.affiliation: Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Bolliger
authors.affiliation: Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.
authors.forename: Christine
authors.initials: C
authors.lastname: Bartsch
authors.affiliation: Genetic Medicine, University Hospitals of Geneva, Switzerland.
authors.forename: Siv
authors.initials: S
authors.lastname: Fokstuen
authors.affiliation: Department of Cardiology, Inselspital, University Hospital Bern, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Gräni
authors.affiliation: Zurich Institute of Forensic Medicine, University of Zurich, Switzerland.
authors.forename: Viktor
authors.initials: V
authors.lastname: Martos
authors.affiliation: Arrhythmias and Cardiogenetics, Inselspital, University Hospital Bern, Switzerland.
authors.forename: Argelia
authors.initials: A
authors.lastname: Medeiros Domingo
authors.affiliation: Service of Legal Medicine Canton Ticino Switzerland and University Center of Legal Medicine University of Insubria-Varese, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Osculati
authors.affiliation: Division of Human Genetics, Department of Pediatrics, Inselspital, University of Bern, Switzerland.
authors.forename: Claudine
authors.initials: C
authors.lastname: Rieubland
authors.affiliation: University Center of Legal Medicine Lausanne-Geneva, University Hospitals Geneva, Switzerland.
authors.forename: Sara
authors.initials: S
authors.lastname: Sabatasso
authors.affiliation: Department of Cardiology, University Heart Center Zurich, Switzerland.
authors.forename: Ardan M
authors.initials: AM
authors.lastname: Saguner
authors.affiliation: Institute of Forensic Medicine, University of Bern, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Schyma
authors.affiliation: Institute of Forensic Medicine, University of Bern, Switzerland.
authors.forename: Joelle
authors.initials: J
authors.lastname: Tschui
authors.affiliation: Institute of Pathology and Forensic Medicine, Kantonsspital Graubünden, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wyler
authors.affiliation: Service of Medical Genetics, University Hospital of Lausanne, Switzerland.
authors.forename: Zahurul A
authors.initials: ZA
authors.lastname: Bhuiyan
authors.affiliation: Service of Medical Genetics, University Hospital of Lausanne, Switzerland.
authors.forename: Florence
authors.initials: F
authors.lastname: Fellmann
authors.affiliation: University Center of Legal Medicine Lausanne-Geneva, University Hospital Lausanne, Switzerland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Michaud
mesh_terms: D000367:Age Factors; D001344:Autopsy / Q000379:methods*; D002423:Cause of Death; D003142:Communication; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D005190:Family; D049429:Forensic Pathology / Q000379:methods*; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000379:methods*; D006801:Humans; D013557:Switzerland