Comparing adolescent- and adult-onset unexplained cardiac arrest: Results from the Dutch Idiopathic VF Registry

Background: Current cohorts of patients with idiopathic ventricular fibrillation (IVF) primarily include adult-onset patients. Underlying causes of sudden cardiac arrest vary with age; therefore, underlying causes and disease course may differ for adolescent-onset vs adult-onset patients. 

Objective: The purpose of this study was to compare adolescent-onset with adult-onset patients having an initially unexplained cause of VF. 

Methods: The study included 39 patients with an index event aged ≤19 years (adolescent-onset) and 417 adult-onset patients from the Dutch Idiopathic VF Registry. Data on event circumstances, clinical characteristics, change in diagnosis, and arrhythmia recurrences were collected and compared between the 2 groups. 

Results: In total, 42 patients received an underlying diagnosis during follow-up (median 7 [2–12] years), with similar yields (15% adolescent-onset vs 9% adult-onset; P =.16). Among the remaining unexplained patients, adolescent-onset patients (n = 33) had their index event at a median age of 17 [16–18] years, and 72% were male. The youngest patient was aged 13 years. In comparison with adults (n = 381), adolescent-onset patients more often had their index event during exercise (P <.01). Adolescent-onset patients experienced more appropriate implantable cardioverter-defibrillator (ICD) therapy during follow-up compared with adults (44% vs 26%; P =.03). Inappropriate ICD therapy (26% vs 17%; P =.19), ICD complications (19% vs 14%; P =.41), and deaths (3% vs 4%; P = 1) did not significantly differ between adolescent-onset and adult-onset patients. 

Conclusion: IVF may occur during adolescence. Adolescent-onset patients more often present during exercise compared with adults. Furthermore, they are more vulnerable to ventricular arrhythmias as reflected by a higher incidence of appropriate ICD therapy.