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.
Highlights
It is public knowledge that physical activity promotes health because once practiced properly, it brings benefits regardless of age, sex, or ethnicity
Sudden cardiac death (SCD) is defined by the 2015 Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death European Society of Cardiology (ESC) Guidelines as an unexpected, non-traumatic death within 1 h of symptoms’ onset in a patient known to have a potentially fatal cardiac condition, or when autopsy finds a cardiac or vascular anomaly as the probable cause, or when no extracardiac causes are found in the postmortem examination, and an arrhythmic event is the likely cause of death [1]
The last American College of Cardiology (ACC)/The American Heart Association (AHA) guidelines consider an indication for implantable cardiac defibrillator (ICD) implant for primary prevention: family history of SCD in first-degree relatives, left ventricle (LV) wall thickness of ≥30 mm, and recent unexplained syncope
Summary
It is public knowledge that physical activity promotes health because once practiced properly, it brings benefits regardless of age, sex, or ethnicity. Rare, sudden cardiac death may occur in the exercise context. When it happens to famous athletes, it reaches the journalistic spotlight and tends to cause public clamor since they are public figures and symbols of health. Strategies trying to mitigate it have been developed by the local arrhythmia societies. The development and implementation of these guidelines are challenging due to many factors such as the non-unanimous athlete definition, the varying etiology of sudden cardiac death between different ages and the geographic areas, and the difficulty to develop studies in the field due to the low incidence
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