Primordial symptoms and electrocardiogram among sudden cardiac death
victims due to primary myocardial fibrosis
Abstract
Background. Sudden cardiac death (SCD) remains a major cause of
death despite progress in prevention and intervention of cardiac
diseases. The most common cause of non-ischemic SCD in young individuals
in Northern Finland is primary myocardial fibrosis (PMF).
Methods. Fingesture study consists of 5,869 systematically
autopsied subjects with SCD from Northern Finland collected from 1998 to
2017. Nonischemic etiology was the cause of SCD in 1477 (25%) subjects
out of which primary myocardial fibrosis was the cause of SCD in 184
(12%) subjects (65% men, median age 55±16 years). Medico-legal
autopsies in PMF subjects showed no other noncardiac organ changes or
prior diseases that could have caused myocardial fibrosis detected at
gross dissection and histological analyses. We examined the ante mortem
ECG and medical history of the subjects to discover preceding symptoms
and ECG changes. Results. Prior health care contact in
electronic health record system was found for 89 (48%) subjects and ECG
was available for 52 (28%) subjects; 20 subjects both medical history
and ECG were available. We observed that transient loss of consciousness
(TLOC) was the most common symptom recorded and was reported by
33 (37%) subjects. ECG was abnormal in 38 (73%) subjects. Fragmented
QRS (fQRS) complex was found in 26 (50%) subjects. Other ECG findings
were prolonged QTc (>450ms in men and >470ms
in women) in 10 (19%), T-inversions in 4 (8%), pathological Q-waves in
3 (6%), and prolonged QRS (> 110 ms) in 3 subjects. Vast
majority, 87% of subjects had either TLOC or abnormal ECG. Only 7
subjects with ECG or ERS history available had normal ECG and did not
have previous TLOC. Conclusions. Most subjects with PMF had
abnormal ECG or previous TLOC. The results suggest that the combination
should generate careful cardiovascular examination in order to detect
underlying myocardial disease and possibly prevent SCD.