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Diagnosis

N

Diagnosis

N

Diagnosis

N Relati v es of unexplained su d den death decedent

Medical histo r y P h ysical examination Standa r d and high p r eco r dial lead ECG Echoca r diogr a p h y E x e r cise testing

Clinical and/or genetic diagnosis

Manage r elati v es acco r ding to condition

Ambulato r y ca r diac r h ythm

monitoring and CMR

(Class IIb)

F oll o w-up f or child

f f r en of decedent Discharge asymptomatic adults c

(Class I)

Non-autopsied sudden death decedent with y oung ag e , fami

, l y histo r y of SCD or ci r cumstances suggesti v e of heritable hea r t disease S ADS decedent

Genetic testing negati v e

or not per f ormed

f f

(age <50 y ears or ci r cumstances or

fami l y histo r y suggesti v e

of heritable disease) S ADS decedent

Pathogenic m utation identified

Familial e valuation in first-deg r ee r elati v es, or r elati v es with suspicious

symptoms (Class I)

(Class I)

Y

Y

Y Familial e valuation in

first-deg r ee r elati v es, obligate ca r riers or r elati v es with suspicious symptoms

acco r ding to condition

(Class I) Genetic counselling and cascade testing f or

f f r elati v es (Class I)

Sodium channel

bloc k er test

k k a (Class IIa)

Epinephrine test b

(Class IIb)

Figure 8 Algorithm for the evaluation of relatives of unexplained sudden death decedents. CMR, cardiac magnetic resonance; ECG, electrocardiogram; N, No; SADS, sudden arrhythmic death syndrome; SCD, sudden cardiac death; Y, Yes. aOver 16 years old + any suspicions for Brugada syndrome on tests or decedent circumstances of death. bIf exercise is not feasible. cRe-evaluate if change in family history or new symptoms. Downloaded from academic.oup.com/eurheartj/article/43/40/3997/6675633 by guest on 07 October 2026