Published online before print December 8, 2003, doi: 10.1161/01.CIR.0000108396.65446.21
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(Circulation. 2003;108:3000.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Circumstances of Death and Gross and Microscopic Observations in a Series of 200 Cases of Sudden Death Associated With Arrhythmogenic Right Ventricular Cardiomyopathy and/or Dysplasia
From Service d’Anatomie-Pathologie (A.T., L.C. D. Meyronnet, F.T., R.L.), Service de Cardiologie et Soins Intensifs (P.C.), and Service de Cardiologie Pédiatrique (P.B.), Hôpital Louis Pradel, Hospices Civils de Lyon, and the Institut de Médecine Légale (A.M., D. Malicier) and CNRS FRE 2692 (P.B.), Faculté de Médecine, Université Claude Bernard Lyon 1, Lyon, France.
Correspondence to Dr Patrice Bouvagnet, Service de Cardiologie Pédiatrique, Hôpital Louis Pradel, BP Lyon Montchat, 69394 Lyon Cedex 03, France. E-mail Patrice.Bouvagnet{at}chu-lyon.fr
Received July 24, 2003; revision received October 1, 2003; accepted October 5, 2003.
Background— Sudden death is a possible consequence of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). Prevalence of ARVC/D in unexpected sudden cardiac death (USCD), however, remains imprecise, as do circumstances of death and ARVC/D-associated gross and microscopic findings, especially His bundle anomalies.
Methods and Results— We reviewed 14 000 forensic autopsies required by judicial authorities from January 1980 to January 1999 in a 2 000 000-resident area. Age, gender, and circumstances of death were recorded. Hearts were examined macroscopically and microscopically. In this series, the ARVC/D group accounted for 200 consecutive cases (10.4%) of USCD, including 108 males and 92 females (average age 32.5 and 34.5 years, respectively). Nearly one third of deaths occurred during the fourth decade of life. Circumstances of death were various, but 75.6% occurred during everyday life events (at home, 63.1%; in the street, 6.6%; or at work, 6.1%); only 7 cases (3.5%) occurred during sports activity. Nineteen cases (9.5%) happened during the perioperative period. Adipose infiltration of the right ventricle was either isolated (20%) or associated with fibrosis (74.5%) and lymphocytes (5.5%). A total of 14.5% of cases had cardiac hypertrophy, assessed by an increase in heart weight and/or left ventricular wall thickness. In most cases, the His bundle and its branches were abnormal either because of infiltration of adipose tissue (8.1%), fibrosis (54.3%), or both (5.6%).
Conclusions— In ARVC/D, both sexes are equally affected, and there is a peak of risk during the fourth decade. Death most frequently occurs during sedentary activity. His abnormalities and left ventricular hypertrophy may be associated with ARVC/D.
Key Words: cardiomyopathy • death, sudden • tissue
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