Risk Factors for Sudden Cardiac Death Similar in Congenital Heart Disease as in Ischemic Heart Disease

The clinical parameters found to be associated with sudden cardiac death (SCD) in adults with a broad spectrum of congenital heart disease (CHD), including systemic right ventricles, are similar to those in ischemic heart disease, according to a study published on Sept. 18 in Circulation.  

Looking at 25,790 adults with CHD, from three databases, the study showed that arrhythmic death occurred in 171 of 1,189 patients. The underlying cardiac lesions were mild, moderate and severe CHD in 12 percent, 33 percent and 55 percent of the SCD cases, respectively. The study also found that clinical variables associated with SCD were supraventricular tachycardia (CVT, OR 3.5, 95 percent CI 1.5=7.9, P=0.004), moderate to severe systemic ventricular dysfunction (OR 3.4, 95 percent CI 1.1-10.4, P=0.034), moderate to severe subpulmonary ventricular dysfunction (OR 3.4, 95 percent CI 1.1-10.2, P=0.030), increased QRS duration (OR 1.34 [per 10 ms increase], 95 percent CI 1.10-1.34, P=0.008), and QT dispersion (OR 1.22 [per 10 ms increase], 95 percent CI 1.22 – 1.48, P=0.008). 

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As the CHD population grows and ages, the risk profile for SCD has the potential to change. According to the study authors, their findings "may be helpful for identifying high risk patients and may guide clinicians in their treatment strategy" – particularly given the fact that a broader spectrum of adults with CHD, even those with cardiac lesions traditionally considered 'mild,' are potentially at risk of SCD.

Moving forward the authors suggest "the need for further prospective studies as well as vigilant ongoing follow-ups of the adult with CHD." 

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