日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

The number of sudden deaths of school students has been decreasing year by year in Japan. The incidence of sudden death in Japanese schools after 2010 decreased to lower than 0.1 per 100,000 students per year from 0.5 in the 1980’s. The use of an automated external defibrillator (AED) by caregivers in schools may have contributed to this result. Some cases of sudden death occur because of previously diagnosed cardiovascular disease identified by the screening system for students in Japanese schools. However, more than half of cases of sudden cardiac arrest in schools are not previously diagnosed with cardiac disease and are partly identified on autopsy. A large part of these are probably caused by genetic life-threatening arrhythmias; therefore, it is necessary to perform as many genetic examinations as possible. Autopsies occasionally reveal structural heart disease as the cause of sudden unexpected cardiac arrest. However, the Japanese forensic system is limited to several big cities. It may be necessary to reconsider the screening system for discovering causative cardiac disease that is often discovered on autopsy. Besides sudden death due to cardiovascular disease, some cases are secondary to central nervous system issues. Sudden unexpected deaths in preschool children, including sudden infant death syndrome, are also reported every year. These also need to be analyzed and discussed for prevention. Cooperation of the screening system and the chain of survival will be expected to contribute to a more marked advance for preventing sudden death.