Identifying patients at risk of sudden arrhythmic death.

Most GPs will encounter at least one case of sudden arrhythmic death syndrome (SADS) during their career. They may have to evaluate a young person at risk of SADS or offer support and screening to family members. SADS is the term used to describe an unexpected death in individuals with no prior history of cardiac disease and where no underlying pathology is identified despite a comprehensive post-mortem evaluation and toxicology screen. in England alone, SADS is responsible for 544 deaths per year, with a mean age of 32 years and a male predominance. Among the 100,000 cases of sudden cardiac death in the UK per year, SADS makes up around 4%, but this proportion is significantly higher in younger cohorts (13% of sudden cardiac deaths in those aged less than 35). Most cases of SADS are the result of inherited cardiac ion channel abnormalities of the heart which predispose to fatal arrhythmias. These include Brugada syndrome, long QT syndrome, short QT syndrome and catecholaminergic polymorphic ventricular tachycardia. Most individuals remain asymptomaticand are diagnosed incidentally on routine ECG testing or family screening. Syncope or cardiac arrest may be the first manifestation, All first-degree relatives of SADS victims should be referred for comprehensive evaluation in an expert setting. In studies of families of SADS victims evaluation of blood relatives identified a hereditary arrhythmogenic syndrome in almost 50% of families, thereby providing a likely cause of ath and preventing further tragedies.