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Clinical characteristics of unexplained sudden cardiac death in Korea
1Division of Cardiology, Chonnam National University Hospital, Kwangju, Korea. chojg@unitel.co.kr
Insights
Sudden cardiac death (SCD) in Korea predominantly affects middle-aged men, often occurring near midnight or late morning without prior symptoms. Idiopathic ventricular fibrillation is a key suspected cause in these unexplained cases.
Area of Science:
- Cardiology
- Public Health
Background:
- Sudden cardiac death (SCD) is a significant concern, with its characteristics varying geographically.
- While coronary artery disease is a common cause in Western countries, the clinical profile of SCD in Korea requires further elucidation.
Purpose of the Study:
- To investigate the clinical characteristics of sudden cardiac death (SCD) in Korean patients.
- To identify potential risk factors and causes of unexplained SCD in this population.
Main Methods:
- Retrospective analysis of 186 sudden cardiac death (SCD) cases admitted to a university hospital over a 4-year period.
- Detailed investigation of clinical presentation, demographics, timing, and electrocardiographic findings in patients with and without structural heart disease.
Main Results:
- Unexplained SCD occurred in 44.1% of cases, predominantly in middle-aged males (80.5%), with a mean age of 50 years.
- Circulatory collapse peaked between midnight and 3 AM (23.5%) and 9 AM and noon (22.1%).
- Idiopathic ventricular fibrillation was diagnosed in 14 patients (66.7% of those with recovered spontaneous circulation).
Conclusions:
- Unexplained SCD is common in Korea, primarily affecting middle-aged men.
- The timing of SCD events and the prevalence of idiopathic ventricular fibrillation suggest specific etiological factors.
- Further research into the mechanisms of idiopathic ventricular fibrillation is warranted to prevent SCD.
Abstract:
In Western countries, sudden cardiac death (SCD) is closely related to coronary artery disease, but in Korea the clinical characteristics of SCD are not well determined. Over a 4-year period (June 1995 to May 1999), 186 cases of SCD, ranging in age from 16 to 75 years, were admitted to the Chonnam National University Hospital. In 82 (44.1%) of these, neither symptoms nor evidence of structural heart disease was found and so their clinical characteristics were investigated. There were 66 (80.5%) men and 16 (19.5%) women (male/female ratio = 4.1:1). The mean age was 50 +/- 14 years: 19 (23.2%) were in their 40s, 21 (25.6%) in their 50s, and 17 (20.7%) in their 60s. The time of circulatory collapse witnessed in 68 cases of SCD showed 2 peaks: between midnight and 03.00h (n=16, 23.5%) and between 09.00h and midday (n=15, 22.1%). Unexplained SCD occurred at home in 48 (64.9%) cases and on the street in 12 (16.2%); it occurred during normal daily routine activity in 23 (39.6%) and during sleep in 15 (25.9%). Thirty-three patients (40.2%) experienced various prodromal symptoms, including chest discomfort (n=13, 15.9%) and dyspnea (n=8, 9.8%). The electrocardiogram taken on arrival recorded asystole in 65 (79.3%) and ventricular fibrillation in 17 (20.7%). Idiopathic ventricular fibrillation was diagnosed in 14 (10 men, 4 women; 45 +/- 11 years) of 21 patients who recovered spontaneous circulation. Five (6.1%) patients were discharged alive, and an implantable cardioverter-defibrillator was implanted in 2. Unexplained SCD is common in Korea and develops predominantly in middle-aged males around midnight or in the late morning usually with no prodromal symptoms (59.8%). Idiopathic ventricular fibrillation is thought to be one of the important causes.