Sudden Cardiac Death in Athletes

Abstract

Physical activity confers substantial health benefits to healthy individuals and patients alike. Occasionally, however, exercise may act as a trigger for arrhythmic death in athletes who harbor an occult pathological substrate. The majority of sudden cardiac deaths (SCDs) in young athletes (≤35 years old) are secondary to inherited cardiac diseases, while ischaemic heart disease predominates in older athletes. In the absence of compulsory national or international registries of SCD in athletes, it is difficult to define the exact scale of the problem. In addition, the lack of post-mortem evaluation by pathologists with expertise in cardiac adaptation to exercise and inherited cardiac diseases casts doubt to the reliability of the reported causes. The proposed preventative strategies focus primarily on preventing deaths by cardiovascular evaluation of athletes and the use of automated external defibrillators in athletic venues. Cardiovascular screening of first-degree relatives, though often neglected, has the potential to avert further tragedies given the inherited nature of most conditions predisposing to SCD in the young. This article provides an overview of the epidemiology and causes of SCD in athletes and explores potential prevention strategies.

Keywords: Sudden cardiac death; athlete; cardiomyopathy; coronary artery disease; ion channelopathy; pre-participation screening; risk assessment.

Figure 1:. Comparison of Causes of Sudden Cardiac Death

Figure 2:. Yield of Genetic Cardiovascular Conditions from Familial Evaluation Following Sudden Arrhythmic Death Syndrome

Figure 3:. Pre-participation Screening Protocols for Young Competitive Athletes (A) and Older Adults (B) Undertaking High-intensity Physical Activity

Figure 4:. Differences Between the Autopsy Conclusions of Referring General Pathologists and an Expert Cardiac Pathologist

Figure 5:. Principles of Managing SCD