[Sudden death in competitive athletes]

Abstract

In athletes under the age of 35 years the incidence of sudden death is low, most causes to be due to ventricular arrhythmias, usually provoked by exertion, and nearly always occur in the presence of structural heart disease or abnormalities in the conduction system. The most common structural disease is hypertrophic cardiomyopathy followed by coronary artery anomalies, idiopathic dilated cardiomyopathy, arrhythmogenic right ventricular dysplasia, aortic stenosis, myocarditis, the Wolff-Parkinson-White syndrome, and long QT syndrome. The evaluation of athletes with symptoms of cardiac arrhythmias, syncope, family history of sudden death require a complete cardiac workup. If they have documented hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, idiopathic dilated cardiomyopathy, long QT syndrome, family history presentation with sudden death, and septal thickness greater than 20 mm competitive athletics are generally prohibited. In athletes with asymptomatic bradyarrhythmia, supraventricular tachycardias and atrial premature contractions without structural heart disease all competitive sports are allowed if heart rate in bradyarrhythmia appropriately increases with exercise. Athletes with premature ventricular contraction, nonsustained ventricular tachycardia and non structural heart disease are without athletic restriction as long as the arrhythmia does not worsen on exertion and cause dyspnea, presyncope or syncope.