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.
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.
Authors: Nabil Ghorayeb; Ricardo Stein; Daniel Jogaib Daher; Anderson Donelli da Silveira; Luiz Eduardo Fonteles Ritt; Daniel Fernando Pellegrino Dos Santos; Ana Paula Rennó Sierra; Artur Haddad Herdy; Claúdio Gil Soares de Araújo; Cléa Simone Sabino de Souza Colombo; Daniel Arkader Kopiler; Filipe Ferrari Ribeiro de Lacerda; José Kawazoe Lazzoli; Luciana Diniz Nagem Janot de Matos; Marcelo Bichels Leitão; Ricardo Contesini Francisco; Rodrigo Otávio Bougleux Alô; Sérgio Timerman; Tales de Carvalho; Thiago Ghorayeb Garcia Journal: Arq Bras Cardiol Date: 2019-03 Impact factor: 2.000
Authors: Cameron H Landry; Katherine S Allan; Kim A Connelly; Kris Cunningham; Laurie J Morrison; Paul Dorian Journal: N Engl J Med Date: 2017-11-16 Impact factor: 91.245
Authors: Gherardo Finocchiaro; Harshil Dhutia; Belinda Gray; Bode Ensam; Stathis Papatheodorou; Chris Miles; Aneil Malhotra; Zeph Fanton; Paulo Bulleros; Tessa Homfray; Adam A Witney; Nicholas Bunce; Lisa J Anderson; James S Ware; Rajan Sharma; Maite Tome; Elijah R Behr; Mary N Sheppard; Michael Papadakis; Sanjay Sharma Journal: Europace Date: 2020-04-01 Impact factor: 5.214