Clinical Characteristics of Unexplained Sudden Cardiac Death in Korea

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 03.00 h (n=16, 23.5%) and between 09.00 h 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. (Jpn Circ J 2001; 65: 18 -22)

Arrhythmogenic Right Ventricular Cardiomyopathy and Sudden Cardiac Death in Young Koreans

“…Also of note, 2 patients died while bathing, as has been reported from southwestern Korea. 19 Many of the present cases were found dead in bed or died suddenly during ordinary daily activity, which is in contrast to the data collected from the Veneto region of Italy. 3,4 A real difference in the incidence of fatal ARVC because of regional or genetic factors may exist or alternatively, it may be that sudden death during strenuous physical activity or exercise does not attract the interest of the public prosecutor in Korea and autopsies were not always requested.…”

“…The large proportion of unexplained SCD during sleep suggests that ARVC may also be related to sudden unexplained nocturnal death syndrome in South-East Asia and Japan. [21][22][23] Similar findings have been also reported from southwestern Korea, 19 suggesting the phenomenon may be common in the Far East. There may be a relationship among sudden unexplained nocturnal death, Brugada syndrome, and ARVC; many Thai and Japanese patients had similar clinical, ECG, and genetic characteristics of Brugada syndrome.…”

Causes of Sudden Death Related to Sexual Activity : Results of a Medicolegal Postmortem Study from 2001 to 2005

“…Previous studies on SD in Korea also showed a high incidence of structurally normal hearts and SD during the night or sleep (16, 17). Cardiac arrest with groaning in patient No.…”

A Latin American Registry of Implantable Cardioverter Defibrillators: The ICD‐LABOR Study

“…Some randomized trials 1–3 have assisted in establishing new guidelines in the therapy of SCD and ICD indications. Despite its utility, 9 the improbability of applying their conclusions to other populations in the world is becoming more evident, especially when publications from different regions emphasize several clinical features being found in their ICD local populations distinct from those described in developed countries 4–6 …”

“…Three classic randomized clinical trials performed in developed countries have provided considerable evidence of increased survival in patients with resuscitated ventricular tachycardia or ventricular fibrillation, treated with an implantable cardioverter defibrillator (ICD) 1–3 . However, these results should not be directly extrapolated to general practice in other populations of the world due to different local conditions and regional pathologies that could modify the results 4–6 . Based on this hypothesis, an assessment of ICDs performance in Latin America was developed.…”