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Research presented at the ESC Preventive Cardiology 2025 congress suggests that recognizing the warning signs of Sudden Arrhythmic Death Syndrome (SADS) could play a critical role in preventing untimely fatalities associated with this condition.
Dr. Matilda Frisk Torell from Sahlgrenska Academy at the University of Gothenburg, Sweden, emphasized the need for greater awareness of SADS, which remains one of the leading causes of sudden cardiac deaths among young individuals, including athletes. “Despite its prevalence, SADS has not received sufficient attention,” she remarked. “Our investigation analyzed a substantial number of sudden cardiac death cases in Sweden to understand SADS’s incidence and identify common precursors to these tragic events, allowing us to pinpoint avenues for prevention.”
This study conducted a retrospective examination of the SUDden cardiac Death in the Young (SUDDY) cohort, which encapsulated 903 instances of sudden cardiac deaths among people aged 1 to 36 in Sweden between 2000 and 2010. For each case, five population-based controls were included. Data were meticulously derived from diverse sources, including death certificates, autopsy findings, medical histories, electrocardiograms (ECGs), biological samples, and information from parents.
According to the findings, SADS was responsible for 22% of all sudden cardiac deaths studied. Notably, the majority of these cases (64%) were male, with a median age of 23 years at the time of death. The study highlighted that 33% of SADS cases had been hospitalized or had received outpatient care within 180 days prior to their death, in contrast to 24% in the control group (p=0.038). Furthermore, 4.2% of SADS cases had a history of hospitalization due to syncope, significantly higher than the 0.41% recorded among controls (p<0.001). Similarly, hospitalizations due to convulsions were reported in 3.5% of SADS cases compared to just 0.14% of controls (p<0.001). A total of 11% had a known arrhythmic condition, and 18% showed abnormal ECG results, with pre-excitation (premature ventricular activation) being the most prevalent finding. Remarkably, approximately 52% reported symptoms prior to death, including palpitations, syncope, nausea/vomiting, and signs indicative of infection. Additionally, 17% had a prior psychiatric diagnosis, and 11% had been prescribed psychotropic medications.
Dr. Frisk Torell noted, “Enhanced awareness of symptoms that could indicate SADS, such as syncope and seizure-like episodes, allows healthcare professionals to better identify at-risk youth during medical consultations. Our findings also call for deeper investigation into the role of psychiatric conditions and treatments as potential risk factors for SADS, as well as exploring how gastrointestinal symptoms and infections might trigger events in susceptible individuals. In particular, preparticipation medical screenings for young athletes represent a crucial opportunity to detect these warning signs and ultimately reduce the incidence of SADS. However, it’s concerning that such screenings are currently not as widespread as they should be.”
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