Causes of Sudden Cardiac Death in Children - Retrospective Study Based on Autopsy Protocols

Background: Sudden cardiac death in children is a rare but tragic event. Studies analyzing sudden cardiac deaths in people aged less than 35 years have demonstrated that the majority of cases are caused by heritable cardiovascular diseases such as cardiomyopathies or arrhythmic syndromes, which are assumed in cases with negative thorough post-mortem examination. Only a few studies focus specifically on children.

Objective: To identify the exact causes of death in cases of sudden potentially cardiac death in children in order to provide the context for implementation of targeted preventive measures. Sudden infant death syndrome victims were also included in the study as fatal arrhythmia is one of the plausible mechanisms.

Methods: Autopsy reports, histological findings, toxicology results and other medical records if available from children aged 0-19 years who died from 2014 to 2019 in a representative area of our country were reviewed by forensic pathologists and a cardiologist.

Results: During the six year study period 57 children (38 boys and 19 girls) died from sudden cardiac death. 45/57 (79%) died during infancy. The death of 41/57 (72%) of children was not explained. 6/57 (11%) died from myocarditis, 5/57 from a cardiomyopathy and 3/57 from a congenital heart defect, other causes were less frequent. The incidence of sudden cardiac death including SIDS in infants and in children aged 1-19 years based on the resident number was estimated at 16/100,000 and 0.24/00,000 person-years, respectively.

Conclusion: Heritable cardiovascular diseases including unexplained deaths and cardiomyopathies were responsible for the vast majority (46/57, 81%) of cases. These results emphasize the need for implementation of post mortem genetic testing and cardiogenetic counselling in the families.

Supported by Ministry of Health of the Czech Republic, grant nr. NV18-02-00237.