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Sudden adult cardiac death is caused by ischaemic heart disease in the vast majority of cases. 1 In previous UK series this cause ranged between 59-86% of sudden death cases in the community. 2, 3 Sudden unexpected cardiac death in the community in which no cause can be found at a coroner's postmortem examination is increasingly recognised. The proportion of unexplained deaths in one of the earliest studies in Wandsworth in 1988 was 3.4%. 2 In the first national prospective study of sudden death, funded by the British Heart Foundation in the early 1990s, a very similar figure of 4.1% of unexplained deaths was reported after detailed examination by three cardiac pathologists. 3 Both these studies advocated identifying these cases by a name, the sudden adult death syndrome (SADS), to highlight the problem and deal with it in a similar fashion to sudden infant death and to study the aetiology systematically. The concept of the morphologically normal heart in sudden death is of major importance with the emergence of the molecular channelopathies such as the long QT or Brugada's syndrome giving rise to lethal cardiac arrhythmias in the past 15 years. 4 Non-ischaemic causes of sudden cardiac death are of major importance because they often include genetic diseases, such as hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy, and arrhythmogenic right ventricular dysplasia (ARVD). 5 After the initial British Heart Foundation study we acted as a referral centre for sudden cardiac death cases from coroners throughout the UK and have now completed an analysis of the cases referred for a pathological opinion, often because the referring pathologist did not find a cause of death or was uncertain of the cause of death. The patients were all older than 15 years, and atherosclerotic coronary artery disease (coronary artery stenosis, with or without acute or old myocardial infarction or fibrosis) was excluded as a cause of death. This is the first pathological study to evaluate non-atherosclerotic cardiac deaths in the UK population aged over 15 years including elderly patients.
METHODS
From January 1994 to April 2003, all cases of sudden adult cardiac deaths referred to us from coroners throughout the UK were entered on a prospective database. All the patients had been well until their sudden death with no history...