Sudden Cardiac Death Among Adolescents in the United Kingdom

Gherardo Finocchiaro, MD, PHD; Davide Radaelli, MD; Stefano D'Errico, MD; Michael Papadakis, MBBS, MD; Elijah R. Behr, MA, MBBS, MD; Sanjay Sharma, BSC, MBCHB, MD; Joseph Westaby, BM BS, PHD; Mary N. Sheppard, MBBCH, BAO, BSC, MD


J Am Coll Cardiol. 2023;81(11):1007-1017. 

In This Article

Abstract and Introduction


Background: Causes and precipitating factors of sudden cardiac death (SCD) in adolescents are poorly understood.

Objectives: The authors sought to investigate the etiologies of SCD and their association with physical activity in a large cohort of adolescents.

Methods: Between 1994 and June 2022, 7,675 cases of SCD were consecutively referred to our national cardiac pathology center; 756 (10%) were adolescents. All cases underwent detailed autopsy evaluation by expert cardiac pathologists. Clinical information was obtained from referring coroners.

Results: A structurally normal heart, indicative of sudden arrhythmic death syndrome was the most common autopsy finding (n = 474; 63%). Myocardial diseases were detected in 163 cases (22%), including arrhythmogenic cardiomyopathy (n = 36; 5%), hypertrophic cardiomyopathy (n = 31; 4%), idiopathic left ventricular hypertrophy (n = 31; 4%), and myocarditis (n = 30; 4%). Coronary artery anomalies were identified in 17 cases (2%). Decedents were competitive athletes in 128 cases (17%), and 159 decedents (21%) died during exercise. Arrhythmogenic cardiomyopathy was diagnosed in 8% of athletes compared with 4% of nonathletes (P = 0.05); coronary artery anomalies were significantly more common in athletes (9% vs 1%; P < 0.001), as well as commotio cordis (5% compared with 1% in nonathletes; P = 0.001). The 3 main comorbidities were asthma (n = 58; 8%), epilepsy (n = 44; 6%), and obesity (n = 40; 5%).

Conclusions: Sudden arrhythmic death syndrome and myocardial diseases are the most common conditions diagnosed at autopsy in adolescent victims of SCD. Among causes of SCD, arrhythmogenic cardiomyopathy, coronary artery anomalies, and commotio cordis are more common in young athletes than in similar age sedentary individuals.


Sudden cardiac death (SCD) is a tragic event that occasionally affects young individuals. A spectrum of cardiac conditions may cause SCD with variable prevalence depending on the age and other demographics of the cohort. Inherited cardiac diseases, such as cardiomyopathies and channelopathies, are the predominant cardiac causes in individuals <35 years of age.[1] Autopsy is an essential first diagnostic step that guides clinical evaluation of surviving relatives toward inherited structural diseases or primary arrhythmogenic syndromes.

Adolescence is the period of life between childhood and adulthood, from ages 10 to 19 years. It is an important phase of development with rapid physical and psychological growth. Genetic conditions that cause SCD may express during the peripuberal phase transitioning from a preclinical state to overt phenotype.[2,3] Therefore, knowledge regarding the precise causes and precipitating factors for SCD in this specific subgroup is required to implement prevention through screening methods and widespread availability of automated external defibrillators (AEDs). Screening with electrocardiograms (ECGs) may facilitate the early diagnosis of cardiomyopathies and channelopathies,[4–6] but has limited value in detecting coronary artery disease (CAD).[4] Conversely, the AED appears to be more effective in the termination of arrhythmias in individuals with CAD or coronary artery anomalies than in athletes with cardiomyopathy.[7]

The objective of this study was to investigate the causes and circumstances of SCD in a large cohort of adolescents whose heart was referred following a SCD to our cardiovascular pathology center and examined by expert cardiac pathologists.