Unique clinical features and long term follow up of survivors of sudden cardiac death in an Asian multicenter study

Abstract

There has been no long-term clinical follow-up data of survivors or victims of sudden cardiac death (SCD). The Taiwan multi-center sudden arrhythmia death syndrome follow-up and clinical study (TFS-SADS) is a collaborative multi-center study with median follow-up time 43 months. In this cohort, the clinical characteristics of these SADS patients were compared with those with ischemic heart disease (IHD). In this SCD cohort, around half (42%) were patients with IHD, which was different from Caucasian SCD cohorts. Among those with normal heart, most had Brugada syndrome (BrS). Compared to those with SADS, patients with IHD were older, more males and more comorbidities, more arrhythmic death, and lower left ventricular ejection fraction. In the long-term follow-up, patients with SADS had a better survival than those with IHD (p < 0.001). In the Cox regression analysis to identify the independent predictors of mortality, older age, lower LVEF, prior myocardial infarction and history of out-of-hospital cardiac arrest were associated with higher mortality and beta blocker use and idiopathic ventricular fibrillation or tachycardia (IVF/IVT) with a better survival during follow-up. History of prior MI was associated with more arrhythmic death. Several distinct features of SCD were found in the Asia–Pacific region, such as higher proportion of SADS, poorer prognosis of LQTS and better prognosis of IVF/IVT. Patients with SADS had a better survival than those with IHD. For those with SADS, patients with channelopathy had a better survival than those with cardiomyopathy.

Ethnic and racial differences in Asian populations with ion channelopathies associated with sudden cardiac death

“…The main results showed that 42% of patients in the Taiwanese SCD cohort also had ischemic heart disease, which was lower than Caucasian SCD patients. Survival studies demonstrated that sudden arrhythmic death syndrome patients had higher survival rates than those with ischemic heart disease (P < 0.001) (9). SCD in this particular ethnic population included a higher proportion of sudden arrhythmic death syndrome patients, a better prognosis for those with idiopathic ventricular fibrillation or idiopathic ventricular tachycardia, and a poor prognosis for individuals with LQTS (9).…”

“…Survival studies demonstrated that sudden arrhythmic death syndrome patients had higher survival rates than those with ischemic heart disease (P < 0.001) (9). SCD in this particular ethnic population included a higher proportion of sudden arrhythmic death syndrome patients, a better prognosis for those with idiopathic ventricular fibrillation or idiopathic ventricular tachycardia, and a poor prognosis for individuals with LQTS (9). Individuals diagnosed with this condition that also presented channelopathies had better survival rates than those with cardiomyopathies (9).…”

“…Unique clinical features and long term follow up of survivors of sudden cardiac death in an Asian multicenter study (9).…”

“…On the other hand, inherited cardiac conditions known as sudden arrhythmic death syndrome usually predispose younger individuals to SCD. A Taiwan clinical study and follow-up (2005-2016) looked at 730 patients after a median time period of 43 months (9). The main results showed that 42% of patients in the Taiwanese SCD cohort also had ischemic heart disease, which was lower than Caucasian SCD patients.…”

Cardiomyopathy in Asian Cohorts: Genetic and Epigenetic Insights

“…Different HF causes are prevalent in Asian and White SCD cohorts. [13][14][15] Although most White patients with SCD had ischemic heart disease, nonischemic heart disease including cardiomyopathies was more common in the only Asian SCD cohort investigated to date. Distinctions in clinical characteristics and disease outcomes have also been observed between Asian and White cardiomyopathy patients; among other factors, differences in the underlying genetics of cohorts may underlie the discrepant clinical features and outcomes.…”