Etiology of Sudden Death in Sports

• Published in: Journal of the American College of Cardiology Vol. 67; no. 18; pp. 2108 - 2115
• Main Authors: Finocchiaro, Gherardo, MD, Papadakis, Michael, MBBS, MD, Robertus, Jan-Lukas, MD, Dhutia, Harshil, MBBS, Steriotis, Alexandros Klavdios, MD, PhD, Tome, Maite, MD, PhD, Mellor, Greg, MBChB, Merghani, Ahmed, MBBS, Malhotra, Aneil, MBBChir, Behr, Elijah, MBBS, MD, Sharma, Sanjay, MBChB, MD, Sheppard, Mary N., MBBCh, BAO, MD
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 10.05.2016
• Subjects: arrhythmogenic right ventricular cardiomyopathy; athletes; Cardiovascular; Internal Medicine; sudden death; AED; ARVC; coronary artery disease; CAD; athletes; LV; sudden cardiac death; sudden death; HCM; left ventricular hypertrophy; SCD; arrhythmogenic right ventricular cardiomyopathy; sudden arrhythmic death syndrome; hypertrophic cardiomyopathy; left ventricular; SADS; automatic external defibrillator; LVH
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2016.02.062

Abstract Background Accurate knowledge of causes of sudden cardiac death (SCD) in athletes and its precipitating factors is necessary to establish preventative strategies. Objectives This study investigated causes of SCD and their association with intensive physical activity in a large cohort of athletes. Methods Between 1994 and 2014, 357 consecutive cases of athletes who died suddenly (mean 29 ± 11 years of age, 92% males, 76% Caucasian, 69% competitive) were referred to our 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. Results 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 of age), whereas myocardial disease was more common in older individuals. SCD during intense exertion occurred in 61% of cases; ARVC and left ventricular fibrosis most strongly predicted SCD during exertion. Conclusions Conditions predisposing to SCD in sports demonstrate a significant age predilection. The strong association of ARVC and left ventricular fibrosis with exercise-induced SCD reinforces the need for early detection and abstinence from intense exercise. However, almost 40% of athletes die at rest, highlighting the need for complementary preventive strategies.