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Embargoed for Release Until After 9 a.m. PDT, Thursday, May 7

PAYING ATTENTION TO WARNING SIGNS MAY HELP PREVENT SUDDEN ARRHYTHMIC DEATH IN YOUNG PEOPLE

SAN DIEGO ñ New research suggests many young people at risk for sudden cardiac death have early warning symptoms that, if recognized, can lead to life-saving treatment.

A quarter of young people who died suddenly of heart rhythm disorders had symptoms such as fainting frequently or during exercise, according to a study being presented at the 19th Annual Scientific Sessions of the North American Society of Pacing and Electrophysiology (NASPE). Another quarter had minor symptoms, including heart palpitations, dizziness, weakness, shortness of breath and chest pain. More than a third of those studied died during physical activity.

Such heart rhythm disorders kill more than 2,000 people a year in the United States, according to the American Heart Association.

"Patients with major warning signs must be studied, including use of monitoring devices, an EKG which specifically looks for underlying disease, and even invasive studies, including coronary artery angiography and biopsy in some patients," said Domenico Corrado, M.D., a consultant in clinical cardiology at the University of Padua, Italy.

Young people determined to be at higher risk may take an anti-arrhythmic drug or beta blocker or receive an implantable cardioverter defibrillator (ICD), a device that detects irregular rhythms and shocks the heart back to a normal beat.

The University of Padua study reviewed the clinical history and autopsy findings of 219 young people (age 1 to 35 years old) who died of arrhythmia. Researchers found 55 (25 percent) had major warning signs: 49 had fainted recurrently or during exercise, and 6 suffered cardiac arrest but were resuscitated with external defibrillation. Minor symptoms, including palpitations, dizziness, weakness and general chest pain, occurred in 103 (47 percent).

Out of the group, 37 (17 percent) were athletes who died during athletic competition. Of the remaining deaths, 44 (20 percent) occurred during moderate activity, such as dancing.

Sudden arrhythmic death is caused by a number of different disorders including cardiomyopathy, or an enlarged heart, coronary artery disease and valve disease. The majority of people studied had no idea they had heart problems. A minority of those with a history of fainting or cardiac arrest were being treated with beta blockers or amiodarone, an anti-arrhythmic drug.

"It's important that young people get help if, for instance, they're running and, with no warning signs, they faint and fall to the ground," said Jeffrey P. Moak, M.D., director of electrophysiology and pacing at Children's National Medical Center, Washington, D.C. "The child should be studied using EKGs, stress tests, halter monitoring and, if it's a child who has had heart surgery, further electrophysiological studies."

Dr. Moak is developing the only national registry of children and young adults who have been stricken by sudden cardiac arrest, which is often triggered by heart rhythm problems.

"The registry is in the early stages, but we'd like to see it get bigger so we can identify markers that might point out patients who are at higher risk, particularly those that don't have the more obvious warning signs such as fainting during exercise," said Dr. Moak, who is also a professor of pediatrics at George Washington University School of Medicine. "Then we can take appropriate measures, such as prescribing anti-arrhythmic drugs or implanting ICDs."

The three-year-old registry includes 83 children from 25 institutions. Dr. Moak is encouraging doctors nationwide to contact him regarding cases of children who have had sudden cardiac arrest.

Co-authors of a paper on sudden arrhythmic death in young people presented by Dr. Corrado are: Cristina Basso, M.D., and Gaetano Thiene, M.D.

Based in Natick, Mass., the North American Society of Pacing and Electrophysiology is a professional organization of physicians, scientists and allied professionals throughout the world dedicated to the study and management of cardiac arrhythmias. Its mission is to improve the care of patients by promoting research, education and training, and providing leadership towards optimal policies and standards.

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[Editors note: For more information, contact the NASPE Web site at www.naspe.org.]