Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Faculty of Medical Sciences, Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Frederik V's vej 11, 2100 Copenhagen Ø, Denmark.
Europace. 2018 Apr 1;20(4):614-621. doi: 10.1093/europace/euw435.
Several drugs increase the risk of ventricular fibrillation and sudden cardiac death (SCD). We aimed to investigate in detail the toxicological findings of all young SCD throughout Denmark.
Deaths in persons aged 1-49 years were included over a 10-year period. Death certificates and autopsy reports were retrieved and read to identify cases of sudden death and establish cause of death. All medico-legal autopsied SCD were included and toxicological reports collected. Positive toxicology was defined as the presence of any substance (licit and/or illicit). All toxicological findings had previously been evaluated not to have caused the death (i.e. lethal concentrations were excluded). We identified 620 medico-legal autopsied cases of SCD, of which 77% (n = 477) were toxicologically investigated post-mortem, and 57% (n = 270) had a positive toxicology profile. Sudden cardiac death with positive toxicology had higher rates of sudden arrhythmic death syndrome (SADS), compared with SCD with negative toxicology (56% vs. 42%, P < 0.01). In total, 752 agents were detected, and polypharmacy (defined as the presence of more than one drug) was present in 61% (n = 164), all substances combined. Psychotropic drugs were the most frequent (62%, n = 467), and 82% (n = 385) were in pharmacological or subpharmacological levels.
We found that more than half of all toxicologically investigated SCD victims have positive post-mortem toxicological findings, and polypharmacy is displayed in a considerable proportion. SCD with positive toxicology had higher rate of SADS, suggesting that the compounds may play a proarrhythmic role in these cases.
有几种药物会增加心室颤动和心脏性猝死（SCD）的风险。我们旨在详细研究丹麦所有年轻 SCD 的毒理学发现。
在 10 年期间纳入了 1-49 岁人群的死亡病例。检索并阅读死亡证明和尸检报告，以确定猝死病例并确定死因。所有医学法律尸检的 SCD 均包括在内，并收集了毒理学报告。阳性毒理学定义为存在任何物质（合法和/或非法）。所有毒理学发现先前均经过评估，认为不会导致死亡（即排除了致命浓度）。我们确定了 620 例医学法律尸检的 SCD 病例，其中 77%（n=477）进行了死后毒理学调查，57%（n=270）有阳性毒理学特征。阳性毒理学的 SCD 猝死的心律失常性猝死综合征（SADS）发生率高于阴性毒理学的 SCD（56% vs. 42%，P<0.01）。总共检测到 752 种药物，联合用药（定义为存在一种以上药物）占 61%（n=164），所有药物均包括在内。精神药物最常见（62%，n=467），82%（n=385）处于药理学或亚药理学水平。
我们发现，超过一半的所有经过毒理学调查的 SCD 受害者有阳性的尸检毒理学发现，并且联合用药在相当大的比例中显示。阳性毒理学的 SCD 猝死的 SADS 发生率更高，这表明这些化合物在这些病例中可能发挥致心律失常作用。
