Etiology of Sudden Cardiac Death in Sports
What are the causes of athlete sudden cardiac death (SCD), and is there an association between athlete SCD and intensive physical activity?
Between 1994 and 2014, 357 consecutive cases of athletes who died suddenly (ages 29 ± 11 years, 92% male, 76% Caucasian, 69% competitive) were referred to the authors’ cardiac pathology center. All subjects underwent detailed post-mortem evaluation, including histological analysis by an expert cardiac pathologist. Clinical information was obtained from referring coroners.
Sudden arrhythmic death syndrome (SADS) was the most prevalent cause of death (n = 149, 42%). Myocardial disease was detected in 40% of cases, including idiopathic left ventricular hypertrophy (LVH) and/or fibrosis (n = 59, 16%), arrhythmogenic right ventricular cardiomyopathy (ARVC, 13%), and hypertrophic cardiomyopathy (HCM, 6%). Coronary artery anomalies occurred in 5% of cases. SADS and coronary artery anomalies affected predominantly young athletes (≤35 years), whereas myocardial disease was more common in older individuals. SCD during intense exertion occurred in 61% of cases; ARVC and idiopathic LV fibrosis most strongly predicted exertion-associated SCD.
Conditions predisposing to SCD in sports demonstrate a significant age predilection. The authors concluded that a strong association of ARVC and idiopathic LV fibrosis with exercise-induced SCD reinforces the need for early detection and abstinence from intense exercise among individuals at risk. However, almost 40% of athletes died at rest, highlighting the need for complementary preventive strategies.
Causes of SCD in athletes vary with the age of the athlete. This pathological review performed among a relatively large number of athletes in the United Kingdom who suffered SCD reinforces the heterogeneity of underlying conditions. Preparticipation screening might be able to detect some (e.g., LVH, HCM ARVC), but not other conditions (e.g., coronary artery anomalies) that could put an athlete at risk.
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