Prof. Dr. Johan SaenenCardiology – Rhythm management – CardiogeneticsAntwerp University HospitalUniversity of Antwerp

What móre should we do to preventSudden Cardiac Death ?

Sudden cardiac death

Sudden cardiac death• A leading cause of mortality in the Western world• Estimated incidence of 1-2/1000/year.

Sudden cardiac death 36%Lung Cancer 16%Stroke 16%Breast Cancer 9%Traffic accidents 9%

Sudden cardiac death

• All ages

• Asymptomatic patients

• Often no detectable disease

• SCD 1st symptom in 30%

• Up to 93% lethal arrhythmias

• Normal autopsy

• “Heart Attack – Heart Failure – Heart rupture – Cardiac Arrest”• Underlying diseases:

Sudden cardiac death

10-15% Cardiomyopathies

60-80% Coronary Artery Disease

10-20% Primary Electrical Diseases 1-2% Aortic disease

1-5% Idiopathic Ventricular Fibrillation

Sudden cardiac death

• Primary prevention: AHT, DM, CH, Obesity, Sedentarism, Smoking

• Revascularisation

• Secondary prevention: Controlling Risk factorsHeart failure treatmentICD implantationResynchronisation therapyVT ablation

Prevention of SCD in CAD

VERY LIKELY other high-risk patients out there !

Sudden cardiac deathSCD <45y of age = up to 70% hereditary cause

SCD• Confirm diagnosis

• Identify high-risk relatives

• Pre symptomatic screening

• Prevent transmission to offspring through PGD

SUDS• Molecular autopsy

Sudden cardiac deathGenes have become the key to unlock

SCD prevention

CARDIOGENETICS

PATHOLOGY

ER ICUSCD

Hemodynamic stabilization

CPRBLS

ALS

HD Stabilization - Diagnostic work-up - Therapy - ICDPre-diagnostic triage Prevention

General PracticeAlarmsymptoms Familial history

TriggersHistory

Contemporary management of SCDSudden cardiac death

CARDIOLOGY

Prevention in inherited cardiac diseaseand/or when SCD <45y

Sudden cardiac death

Alarm symptoms:Cardiac syncope = sudden, no trigger, no prodromiSupine syncopeExercise syncopeSymptomatic palpitations

Atrial fibrillation at young ageAngina pectoris at young ageHeart failure signs at young ageUnexplained/’transient’ epilepsy

Prevention in inherited cardiac diseaseand/or when SCD <45y

Sudden cardiac death

Family history alarm signs:“Hartaderbreuk”Heart conditionSyncopes/black-outsSIDS, Sudden death <45yPacemaker or ICDSuspicious traffic accidentsUnexplained (near)drowning

Death in BelgiumWhat is a natural cause of death ?

Death in BelgiumHow do you know

And does not affect family ?

What móre should we do to prevent SCD:

1. SCD < 45y = 70% hereditary

2. Investigate family

3. Recognize alarm symptoms

4. Only declare proven natural cause of deathInsist on autopsy as it may save family members

5. Dedicated cardiogenetics clinic