Molecular autopsy in sudden cardiac death – ethical issues and clinical implication for relatives

Sudden cardiac death is a devastating and tragic event, especially in young, fit and healthy individuals with no prior symptoms or medical conditions. In these cases, death is caused mainly by a variety of inherited cardiac disorders, either with structural abnormalities or purely electrical heart diseases. Although in most cases conventional autopsy is able to establish the cause of death, there are cases when standard post-mortem examination fails to reveal the underlying cause of decease. Molecular autopsy (post-mortem genetic testing) is a requisite for the accurate diagnosis and also a standard of care along with detailed cardiologic assessment and informed genetic counselling of surviving relatives. This multidisciplinary approach could prevent future tragic events and facilitate development of preventive strategies. The goal of this review is to summarize the current state of knowledge regarding various genetic causes of sudden cardiac death emphasizing the requisite of post-mortem genetic testing for identifying surviving relatives at risk for future lethal events.