Editor's Note: Commentary based on Landry CH, Allan KS, Connely KA, et al. Sudden cardiac arrest during participation in competitive sports. N Engl J Med 2017;377:1943-53.

This was a retrospective analysis of cases of out-of-hospital cardiac arrests, identified from the prospectively acquired Rescu Epistry cardiac arrest database (Ontario, Canada) between 2009-2014, that occurred during sport participation in subjects 12-45 years of age. Sport participation was classified as competitive if the activity was organized and certified by an official sports association or non-competitive if the activity was not formally organized or sanctioned by a governing sports authority. Identified cases were then cross-referenced and further adjudicated as sudden cardiac arrest (SCA) versus non-cardiac based on EMS reports, in-hospital medical documentation, autopsy reports for cases of sudden death, and direct interviews with patients or family members when applicable.

74 SCAs occurred during athletic participation over 18.5 million person-years of observation. Of these 74 cases, 16 were classified as SCA during competitive sports (age range 12-44 years, 81% male/19% female) versus 58 during non-competitive sports. Specific to competitive sport participation, sports most commonly associated with SCA were race events and soccer (four cases each) and the incidence of SCA was 0.76 per 100,000 athlete-years with a 44% survival rate at the time of hospital discharge. Of the 16 cases of SCA, there were 9 deaths (two cases of hypertrophic cardiomyopathy, three cases of anomalous coronary arteries, two primary arrhythmic events, two cases of myocardial ischemia). In terms of the potential impact of pre-participation cardiac screening, it was determined that the cause of SCA could have been identified prior to the event in three out of 16 cases.

In this retrospective analysis of cases of out-of-hospital cardiac arrests acquired from a large, prospectively acquired Canadian registry, the incidence of SCA among youthful athletes during participation in competitive sports was 0.76 per 100,000 athlete years. SCA as a consequence of structural cardiomyopathy was uncommon.

Using a large population-based prospective registry and rigorous case adjudication, the authors affirm that the incidence of SCA during competitive sport participation is rare in occurrence. However, it is important to acknowledge that SCA cases that occurred during non-competitive sports or non-physical activity were not included in the reported incidence estimate. In addition, while these data suggest that structural heart disease is an uncommon cause of SCA during active sport participation, the potential value of more extensive pre-participation cardiac screening, including ECG screening, cannot be ascertained from this epidemiologic study.

Keywords: Athletes, Out-of-Hospital Cardiac Arrest, Autopsy, Survival Rate, Retrospective Studies, Prospective Studies, Death, Sudden, Cardiac, Coronary Vessels, Sports, Cardiomyopathy, Hypertrophic, Myocardial Ischemia, Electrocardiography, Registries

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