Sudden Arrhythmic Death During Exercise: A Post-Mortem Genetic Analysis

• Published in: Sports medicine (Auckland) Vol. 47; no. 10; pp. 2101 - 2115
• Main Authors: Campuzano, Oscar, Sanchez-Molero, Olallo, Fernandez, Anna, Mademont-Soler, Irene, Coll, Monica, Perez-Serra, Alexandra, Mates, Jesus, del Olmo, Bernat, Pico, Ferran, Nogue-Navarro, Laia, Sarquella-Brugada, Georgia, Iglesias, Anna, Cesar, Sergi, Carro, Esther, Borondo, Juan Carlos, Brugada, Josep, Castellà, Josep, Medallo, Jordi, Brugada, Ramon
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.10.2017; Springer Nature B.V
• Subjects: Arrhythmia; Autopsies; Autopsy; Cardiac arrhythmia; Cardiomyopathy; Cardiovascular disease; Death; Defibrillators; Deoxyribonucleic acid; DNA; Fatalities; Genes; Genetic analysis; Genetic diversity; Genetic testing; Genetic variance; Heart; Heart attacks; Infarction; Medicine; Medicine & Public Health; Mutation; Myocardial infarction; Next-generation sequencing; Original Research Article; Physical training; Sports Medicine; United States > US; Sudden Cardiac Death; Rare Variant; Catecholaminergic Polymorphic Ventricular Tachycardia; Human Gene Mutation Database; Brugada Syndrome
• ISSN: 0112-1642; 1179-2035
• DOI: 10.1007/s40279-017-0705-3

Background Sudden cardiac death is a natural and unexpected death that occurs within 1 h of the first symptom. Most sudden cardiac deaths occur during exercise, mostly as a result of myocardial infarction. After autopsy, some cases, especially in the young, are diagnosed as cardiomyopathies or remain without a conclusive cause of death. In both situations, genetic alterations may explain the arrhythmia. Objective Our aim was to identify a genetic predisposition to sudden cardiac death in a cohort of post-mortem cases of individuals who died during exercise, with a structurally normal heart, and were classified as arrhythmogenic death. Methods We analyzed a cohort of 52 post-mortem samples from individuals <50 years old who had a negative autopsy. Next-generation sequencing technology was used to screen genes associated with sudden cardiac death. Results Our cohort showed a male prevalence (12:1). Half of the deaths occurred in individuals 41–50 years of age. Running was the most common exercise activity during the fatal event, accounting for 46.15% of cases. Genetic analysis identified 83 rare variants in 37 samples (71.15% of all samples). Of all rare variants, 36.14% were classified as deleterious, being present in 53.84% of all cases. Conclusions A comprehensive analysis of sudden cardiac death-related genes in individuals who died suddenly while exercising enabled the identification of potentially causative variants. However, many genetic variants remain of indeterminate significance, thus further work is needed before clinical translation. Nonetheless, comprehensive genetic analysis of individuals who died during exercise enables the detection of potentially causative variants and helps to identify at-risk relatives.