Sports-related sudden cardiac deaths in the young population of Switzerland

Abstract

Background: In Switzerland, ECG screening was first recommended for national squad athletes in 1998. Since 2001 it has become mandatory in selected high-risk professional sports. Its impact on the rates of sports-related sudden cardiac death (SCD) is unknown.

Objective: We aimed to study the incidence, causes and time trends of sports-related SCD in comparison to SCD unrelated to exercise in Switzerland.

Methods: We reviewed all forensic reports of SCDs of the German-speaking region of Switzerland in the age group of 10 to 39 years, occurring between 1999 and 2010. Cases were classified into three categories based on whether or not deaths were associated with sports: no sports (NONE), recreational sports (REC), and competitive sports (COMP).

Results: Over the 12-year study period, 349 SCD cases were recorded (mean age 30±7 years, 76.5% male); 297 cases were categorized as NONE, 31 as REC, and 21 as COMP. Incidences of SCD per 100,000 person-years [mean (95% CI)] were the lowest in REC [0.43 (0.35-0.56)], followed by COMP [1.19 (0.89-1.60)] and NONE [2.46 (2.27-2.66)]. In all three categories, coronary artery disease (CAD) with or without acute myocardial infarction (MI) was the most common cause of SCD. Three professional athletes were identified in COMP category which all had SCD due to acute MI. There were no time trends, neither in overall, nor in cause-specific incidences of SCD.

Conclusions: The incidence of SCD in young individuals in Switzerland is low, both related and unrelated to sports. In regions, like Switzerland, where CAD is the leading cause of SCD associated with competitions, screening for cardiovascular risk factors in addition to the current PPS recommendations might be indicated to improve detection of silent CAD and further decrease the incidence of SCD.

Fig 1. Distribution of underlying causes of sudden cardiac death and their relation to exercise.

ARVC, arrhythmogenic right ventricular cardiomyopathy; CAD, coronary artery disease; CMP, cardiomyopathy; COMP, SCD related to competitions; DCM, dilated cardiomyopathy; FMD, fibrous muscular dysplasia of coronary artery; HCM, hypertrophic cardiomyopathy; MI, myocardial infarction; MVP, mitral valve prolapse; NONE, SCD not related to physical activities; REC, SCD associated with physical activities other than competitions.

Fig 2. Distribution of underlying causes of sports-related sudden cardiac death.

Distribution of underlying causes of sudden cardiac death (SCD) and their relation to recreational (REC) and competitive sports (COMP) in age groups of 10–35 and 36–39 years. AMI, acute myocardial infarction; ARVC, arrhythmogenic right ventricular cardiomyopathy; CAD, coronary artery disease; CMP, cardiomyopathies; COMP, SCD related to competitions; DCM, dilated cardiomyopathy; HCM, hypertrophic cardiomyopathy; REC, SCD associated with physical activities other than competitions; SCD, sudden cardiac death.

Fig 3. Annual incidence rates of sudden cardiac death in the young population of the German-speaking region of Switzerland.

Young population included individuals aged 10 to 39 years. Sudden cardiac deaths (SCDs) occurring between 1999 and 2010 were evaluated. Incidence rates are presented for NONE, REC and COMP categories classified based on relation of the SCD to sports. COMP, SCD related to competitions; NONE, SCD not related to physical activities; REC, SCD associated with physical activities other than competitions.