Sudden arrhythmic death, a form of sudden cardiac death that occurs without visible structural heart disease, can strike young and seemingly healthy individuals with no prior diagnosis. Although rare, with only about 15 cases per year in Sweden, early warnings often go unrecognized. Now, a new Swedish nationwide study suggests that more frequent or targeted use of electrocardiograms (ECGs) could help identify at-risk individuals before a fatal event.

In the study, researchers at the University of Gothenburg (Gothenburg, Sweden) examined sudden arrhythmic deaths in individuals aged 1 to 35 who died in Sweden between 2000 and 2010. The study used national health and population registers to identify 149 cases in which autopsy revealed no structural heart abnormalities, pointing to fatal disturbances in heart rhythm. Each case was compared with 10 age-, sex-, and region-matched individuals from the general population.

Investigators reviewed medical records, ECG results, and healthcare visits in the months leading up to each death, identifying patterns of symptoms and care-seeking behavior. The findings revealed that half of the individuals who died had earlier warning signs such as fainting or palpitations. One in three had sought medical care within six months before the event, with visits for fainting occurring twenty times more often than among controls, and visits for seizures ten times more often. Nearly one in five had a previously abnormal ECG, highlighting missed opportunities for early detection.

The study, published in The American Journal of Cardiology, underscores the potential value of including ECG testing more frequently in the evaluation of young people with fainting, palpitations, or seizure-like symptoms. Early identification of rhythm disturbances could help guide monitoring, referral, or preventive interventions.

“It’s striking that so many had seen a doctor shortly before the event. It shows that we have an opportunity to identify those at risk before something happens,” said researcher Matilda Frisk Torell.

“The more we understand the symptoms and ECG changes that may come before a sudden arrhythmic death, the better we can identify those at risk,” added researcher Mats Börjesson.

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