Silvola H, Pakanen L, Holmström L, Perkiömäki J S, Eskuri M A E, Huikuri H V, Junttila M J
Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
Forensic Medicine Unit, Finnish Institute for Health and Welfare, Oulu, Finland.
Clin Cardiol. 2025 Jul;48(7):e70057. doi: 10.1002/clc.70057.
Sudden cardiac death (SCD) remains a major cause of death despite progress in prevention and intervention of cardiac diseases. The most common cause of nonischemic SCD in young individuals in Northern Finland is primary myocardial fibrosis (PMF).
Fingesture study consists of 5869 prospectively collected subjects with SCD from Northern Finland collected from 1998 to 2017. Nonischemic etiology was the cause of SCD in 1477 (25%) subjects out of which primary myocardial fibrosis was the cause of SCD in 184 (12%) subjects (65% men, median age 55 ± 16 years). We examined the ante mortem ECG and medical history of the subjects to discover preceding symptoms and ECG changes.
Prior health care contact in electronic health record system (EHR) was found for 89 (48%) subjects and ECG was available for 52 (28%) subjects. Both medical history and ECG were available for 20 subjects (11%). We observed that transient loss of consciousness (TLOC) was the most common symptom recorded and was reported by 33 (37%) subjects. ECG was abnormal in 38 (73%) subjects. Fragmented QRS (fQRS) complex was found in 26 (50%) subjects. Vast majority, 87% of subjects had either TLOC or abnormal ECG. Only seven subjects with ECG or EHR history available had normal ECG and did not have TLOC.
Many SCD victims with primary myocardial fibrosis had abnormal ECG or history of TLOC. The results suggest that the combination should generate careful cardiovascular examination to detect underlying myocardial disease and possibly prevent SCD.
尽管在心脏病的预防和干预方面取得了进展，但心脏性猝死（SCD）仍然是主要的死亡原因。芬兰北部年轻人非缺血性SCD的最常见原因是原发性心肌纤维化（PMF）。
Fingesture研究包括1998年至2017年从芬兰北部前瞻性收集的5869例SCD患者。1477例（25%）患者的SCD病因是非缺血性的，其中184例（12%）患者的SCD病因是原发性心肌纤维化（65%为男性，中位年龄55±16岁）。我们检查了这些患者的死前心电图和病史，以发现先前的症状和心电图变化。
在电子健康记录系统（EHR）中发现89例（48%）患者有先前的医疗接触记录，52例（28%）患者有心电图记录。20例（11%）患者同时有病史和心电图记录。我们观察到，短暂意识丧失（TLOC）是记录到的最常见症状，33例（37%）患者报告有此症状。38例（73%）患者的心电图异常。26例（50%）患者发现碎裂QRS（fQRS）波群。绝大多数（87%）患者有TLOC或心电图异常。只有7例有心电图或EHR病史记录的患者心电图正常且没有TLOC。
许多原发性心肌纤维化导致SCD的患者有心电图异常或TLOC病史。结果表明，综合这些情况应进行仔细的心血管检查，以检测潜在的心肌疾病，并可能预防SCD。
