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Review
. 2021 Feb 14;57(2):168.
doi: 10.3390/medicina57020168.

Sudden Cardiac Death in Athletes: From the Basics to the Practical Work-Up

Adriano Nunes Kochi  1   2 , Giulia Vettor  1 , Maria Antonietta Dessanai  1 , Francesca Pizzamiglio  1 , Claudio Tondo  1   3
Affiliations
Review

Sudden Cardiac Death in Athletes: From the Basics to the Practical Work-Up

Adriano Nunes Kochi et al. Medicina (Kaunas). .

Abstract

Sudden cardiac death in athletes is a relatively rare event, but due to the increasing number of individuals practicing high-performance sports, in absolute terms, it has become an important issue to be addressed. Since etiologies are many and the occurrence is rare, tracing the ideal preparticipation screening program is challenging. So far, as screening tools, a comprehensive clinical evaluation and a simple 12-lead electrocardiogram (ECG) seem to be the most cost-effective strategy. Recent technological advances came to significantly help as second-line investigation tools, especially the cardiac magnetic resonance, which allows for a more detailed ventricular evaluation, cardiac tissue characterization, and eliminates the poor acoustic window problem. This article aims to review all aspects related to sudden cardiac death in athletes, beginning with definitions and epidemiology, passing through etiology and clinical characteristics, then finishing with a discussion about the best ambulatory investigational approach.

Keywords: ICD implant; arrhythmogenic right ventricular cardiomyopathy; athletes; channelopathies; hypertrophic cardiomyopathy; myocarditis; sudden cardiac death; ventricular arrhythmias.

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Conflict of interest statement

None of the authors have conflicts of interest related to this study. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Figures

Figure 1
Figure 1
Findings in a diagnostic work-up of arrhythmogenic cardiomyopathy. (A) Frequent and coupled premature ventricular beats during exercise testing. (B) Sustained ventricular tachycardia. (C) CMR revealing adipose infiltration in the basal septal inferior and posterior, LGE present in the lower basal and anterior basal septal. (D) Histological findings of fibrosis, mature adipocytes, and inflammatory cells. Courtesy from Cardiovascular Pathology, University of Padua.
Figure 2
Figure 2
Suggested sports preparticipation evaluation work-up. ECG: electrocardiogram; SD: sudden death; CV: cardiovascular; CMR: cardiac magnetic resonance.
Figure 3
Figure 3
ECG interpretation flowchart according to the 2017 International Consensus. LA: left atrium; RA: right atrium; LVH: left ventricular hypertrophy; RVH: right ventricular hypertrophy; RBBB: right bundle branch block; TWI: T wave inversion; AV: atrioventricular; LBBB: left bundle branch block; PVC: premature ventricular beat.
See this image and copyright information in PMC

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