Sudden cardiac death in young adults and the role of antipsychotic drugs: a multicenter autopsy study

Sudden cardiac death (SCD) in patients with schizophrenia treated with antipsychotic drugs (APDs) has become a significant concern, with increasing incidence, particularly among young adults. This multicenter study aimed to investigate the cardiac effects of APDs in a cohort of patients who died from SCD. A retrospective analysis was conducted on seven schizophrenic patients, aged 25 to 39 years, who died from SCD while receiving antipsychotic therapy. Patients with cardiovascular risk factors, substance abuse at the time of death, or advanced age were excluded. Autopsies focused on cardiac tissue, and histological and toxicological analyses were performed. The findings revealed structural cardiac changes, including myocardial fibrosis, myofiber disruption, and contraction band necrosis-features consistent with arrhythmic SCD. Toxicological results confirmed APD use in all cases, with polypharmacy patterns commonly observed. The study suggests that APDs can induce significant cardiac alterations that may predispose patients to SCD, even in the absence of pre-existing cardiac disease. These findings underscore the need for careful cardiac monitoring in patients with schizophrenia treated with APDs, particularly those without traditional cardiovascular risk factors. Further research, including molecular autopsy and genetic analysis, is necessary to better understand genetic predispositions and the role of APDs in SCD.