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Febrile seizures prior to sudden cardiac death: a Danish nationwide study
Niels Kjær Stampe1, Charlotte Glinge1, Reza Jabbari1
1Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark.
Insights
Febrile seizures (FS) in early childhood were found to be nearly twice as common in young adults who died suddenly and unexpectedly (SCD). This suggests febrile seizures may be a factor in sudden cardiac death risk stratification.
Area of Science:
- Cardiology
- Neurology
- Pediatrics
Background:
- Febrile seizure (FS) affects 2-5% of children under five.
- Sudden cardiac death (SCD) is a critical concern in young adults.
- The potential link between early childhood FS and later SCD risk is not well-established.
Purpose of the Study:
- To investigate if a history of febrile seizure in early childhood is over-represented in young adults who experience sudden cardiac death.
- To assess the potential of FS as a risk factor in SCD prediction models.
Main Methods:
- A nationwide study of all deaths in Denmark (2000-2009) was conducted.
- Death certificates were reviewed to identify cases of SCD in individuals aged 1-30 years.
- National registries were used to determine the frequency of prior FS in SCD cases, a general population cohort, and transport accident victims.
Main Results:
- The study identified 245 SCD cases and found that 5.7% had a history of FS, significantly higher than the 3.0% in the general population and 2.8% in transport accident victims.
- The odds ratio for FS in SCD cases compared to the general population was 1.96 (95% CI 1.14-3.36).
- Sudden arrhythmic death syndrome was the most common cause of death in SCD cases with a history of FS.
Conclusions:
- A history of febrile seizure in early childhood is associated with a significantly increased risk of sudden cardiac death in young adulthood.
- Febrile seizures may represent a potential biomarker for SCD risk stratification.
- Further research is warranted to explore the underlying mechanisms and clinical implications of this association.
Aims:
Febrile seizure (FS) is a common disorder affecting 2-5% of children up to 5 years of age. The aim of this study was to determine whether FS in early childhood are over-represented in young adults dying from sudden cardiac death (SCD).
Methods And Results:
We included all deaths (n = 4595) nationwide and through review of all death certificates, we identified 245 SCD in Danes aged 1-30 years in 2000-09. Through the usage of nationwide registries, we identified all persons admitted with first FS among SCD cases (14/245; 5.7%) and in the corresponding living Danish population (71 027/2 369 785; 3.0%) and also in victims of transport accidents (26/917; 2.8%). The frequency of FS among SCD cases was significantly increased by an odds ratio of 1.96 [95% confidence interval (CI) 1.14-3.36; P = 0.021] compared with the living Danish population and with an odds ratio of 2.08 (95% CI 1.07-4.04; P = 0.046) compared with transport accident victims. SCD cases did not differ statistically in birth year (P = 0.272), age at SCD (P = 0.667) or prior medical conditions, except for epilepsy (P < 0.001), when comparing SCD with and without prior FS. The most common cause of death in autopsied SCD cases with FS was sudden arrhythmic death syndrome (5/8; 62.5%).
Conclusion:
In conclusion, this study demonstrates a significantly two-fold increase in the frequency of FS prior to death in young SCD cases compared with the two control groups, suggesting that FS could potentially contribute in a risk stratification model for SCD and warrant further studies.
