Heart Rhythm 2022 Aug 4. Epub 2022 Aug 4.
Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand. Electronic address:
Background: SAR-CoV2 vaccination reduces morbidity and mortality associated with Covid-19 disease; unfortunately, it is associated with serious adverse events, including sudden unexplained death (SUD).
Objective: We aimed to study the genetic basis of SUD after Covid-19 vaccination in Thailand.
Methods: From April to December 2021, cases with natural but unexplained death within seven days after Covid-19 vaccination were enrolled for whole exome sequencing.
Results: Thirteen were recruited, aged between 23 and 72 years, 10 (77%) were males, 12 were Thai and one was Australian. Eight (61%) died after receiving the first dose of vaccine and seven (54%) died after ChAdOx1 nCoV-19; however, there were no significant correlations between SUD and either the number or type of vaccine. Fever was self-reported in three cases. Ten (77%) and 11 (85%) died within 24 hours and 3 days after vaccination, respectively. WES analysis revealed five cases harbored SCN5A variants which had previously been identified in patients with Brugada syndrome (BrS), giving an SCN5A variant frequency of 38% (5/13). This is a significantly higher rate than observed in Thai SUD cases occurring 8 - 30 days after Covid-19 vaccination during the same period (10% (1/10)), in a Thai SUD cohort studied before the Covid-19 pandemic (12% (3/25)), and in our in-house exome database (12% (386/3231)).
Conclusions: These findings suggest that SCN5A variants may be associated with SUD within seven days after Covid-19 vaccination, regardless of vaccine type, number of vaccine dose, and presence of underlying diseases or postvaccine fever.