ESC recommends DNA analysis in post mortems of young sudden death victims

August 29, 2015

London, UK - 29 Aug 2015: ESC Guidelines published today recommend DNA analysis as a fundamental component of post mortem assessment in young sudden death victims. Identification of a genetic cause helps to quickly diagnose and protect relatives.

The Guidelines are published online in European Heart Journal1 and on the ESC Website2 and are the European update to the 2006 European/American guidelines.3 They focus on preventing sudden cardiac death in patients with ventricular arrhythmias.

"For the first time these guidelines have incorporated the concept proposed by several consensus documents that DNA analysis should be a fundamental component of post mortem assessment in young sudden death victims," said Professor Silvia Priori, Chairperson of the guidelines Task Force. "The molecular analysis helps to identify the presence of genetic diseases that can occur in a structurally normal heart and therefore cannot be identified during autopsy. Identification of a genetic cause as a substrate for a sudden death facilitates the early diagnosis of affected relatives and may help protect them through a personalised approach that spans from lifestyle modifications to the early use of therapies."

Another innovation is the introduction of "emerging recommendations" which are not yet supported by evidence strong enough for a Class I recommendation but which are highly promising. One example is the Class IIa recommendation, level of evidence C, that supports the use of the old antiarrhythmic drug flecainide in addition to beta-blockers for patients with a diagnosis of catecholaminergic polymorphic ventricular tachycardia who experience recurrent syncope or polymorphic/bidirectional VT while on beta-blockers and have risks/contraindications for an implantable cardioverter defibrillator (ICD).

"This new indication for an old drug is particularly relevant, as it provides an additional therapeutic option for patients with an 'orphan' disease with a limited number of available treatments," said Professor Priori.

With respect to new technologies, two Class IIb recommendations are introduced that cautiously inform the medical community about new treatment options that are still under investigation but could be used in select patients when alternatives are ineffective, unavailable or contraindicated. First, wearable cardioverter defibrillators may be considered for adult patients with poor left ventricular systolic function who are at risk of sudden arrhythmic death for a limited period and are not candidates for an ICD.4 Second, the subcutaneous ICD may be a useful alternative to a transvenous defibrillator when venous access is difficult, after the removal of a transvenous defibrillator due to infections, or in young patients with a long-term need for ICD therapy.

One of the most important recommendations is to identify patients with ischaemic heart disease who are at high risk of sudden cardiac death and may benefit from an ICD. An eight year follow-up of the MADIT II study found that patients with an ejection fraction below 30% and mild to moderate heart failure (NYHA class II and III) had a long-term improvement in survival with an ICD. ESC Guidelines published today recommend re-evaluation of left ventricular function at 6-12 weeks after myocardial infarction to assess the potential need for primary prevention ICD implantation.

"This recommendation is based on the fact that many patients with reduced ejection fraction early after a myocardial infarction will experience an improvement in their condition over time and therefore do not require the implantation of an ICD," said Professor Carina Blomström-Lundqvist, co-Chairperson. "Reassessment of ejection fraction is critical to ensure that all efforts are made to avoid unnecessary ICDs while at the same time identifying patients whose ejection fractions remain low even after medical therapy and who need an ICD."

Cardiac resynchronisation requires further study in a number of areas. "Its use in patients with atrial fibrillation has not been defined outside of observational datasets and there is a clear need for adequately powered randomised trials in this patient group," said Professor Blomström-Lundqvist. "Furthermore, whether the duration or the 'morphology' of the QRS complex is the most important predictive factor for response to therapy remains a challenging issue requiring more extensive investigations."

Professor Priori concluded: "The guidelines emphasise that early diagnosis of disorders that may predispose to sudden cardiac death can save lives. Screening in the general population may be expensive and not all experts support its use. But there is now a broad consensus that cascade screening should always be performed in families of affected individuals and in families with a history of sudden cardiac death in young people."
-end-


European Society of Cardiology

Related Myocardial Infarction Articles from Brightsurf:

Treatment shows reduction in heart failure after myocardial infarction
Researchers at Baylor College of Medicine identified potential preventative therapies for heart failure after a significant heart attack.

The challenges of treating acute myocardial infarction due to variant angina
In a new publication from Cardiovascular Innovations and Applications; DOI https://doi.org/10.15212/CVIA.2019.1262, Wen-Yuan Ding, Jia-Min Li, Fei Zheng, Li-Li Wang, Xin-Yi Wei and Guo-Hua Li from Shandong Provincial Qianfoshan Hospital, Ji'nan, China, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Ji'nan, China and Shandong First Medical University, Tai'an, China consider the challenges of treating acute myocardial infarction due to variant angina.

WeChat group of chest pain center for patients with acute ST-segment elevation myocardial infarction
In a new publication from Cardiovascular Innovations and Applications; DOI https://doi.org/10.15212/CVIA.2019.0590, Liu Yue, Qin Zhu-Yun, Yang Xin, Tang Rong and Gao Ling-Yun from the The First Affiliated Hospital of Chongqing Medical University, Chongqing, China consider the use of a social media platform (WeChat) to provide faster treatment and improve prognoses for a group of patients with acute ST-segment Elevation Myocardial Infarction.

Improved survival after obesity operation in patients with previous myocardial infarction
Researchers at Karolinska Institutet and Danderyd Hospital in Sweden have studied the risk of additional myocardial infarctions and early death in severely obese patients who undergo metabolic surgery following a myocardial event.

Researchers discover a cell type responsible for cardiac repair after infarction
The researcher of the Faculty of Science of the UMA Adrián Ruiz-Villalba, who is also member of the Andalusian Center for Nanomedicine and Biotechnology (BIONAND) and the Biomedical Research Institute of Malaga (IBIMA), is the first author of an international study that has identified the heart cells in charge of repairing the damage caused to this organ after infarction.

Discovery of cells that heal cardiac damage after infarction
Researchers at Cima and the Clinica Universidad de Navarra (Spain) have led an international study identifying the cardiac cells responsible for repairing the damage to this organ after infarction.

CHOP researchers find MIS-C associated with myocardial injury
Using sensitive parameters to assess cardiac function, researchers at Children's Hospital of Philadelphia (CHOP) have found that cardiac involvement in multisystem inflammatory syndrome in children (MIS-C) differs from Kawasaki disease (KD) and is associated with myocardial injury.

Heart attack modeled with human stem cells
A model of ischemic heart disease was developed using human induced pluripotent stem cells (hiPSC).

The relationship between lifetime drinking and non-fatal acute myocardial infarction
New research from the Prevention Research Center of the Pacific Institute for Research and Evaluation suggests that the impact of alcohol consumption on coronary heart disease may be underestimated.

The relationship between mean platelet volume and in-hospital mortality in geriatric patients with ST segment elevation myocardial infarction who underwent primary percutaneous coronary intervention
In the current issue of Cardiovascular Innovations and Applications volume 4, issue 2, pp.

Read More: Myocardial Infarction News and Myocardial Infarction Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.