Original Investigation
Etiology of Sudden Death in Sports: Insights From a United Kingdom Regional Registry

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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.

Key Words

arrhythmogenic right ventricular cardiomyopathy
athletes
sudden death

Abbreviations and Acronyms

AED
automatic external defibrillator
ARVC
arrhythmogenic right ventricular cardiomyopathy
CAD
coronary artery disease
HCM
hypertrophic cardiomyopathy
LV
left ventricular
LVH
left ventricular hypertrophy
SADS
sudden arrhythmic death syndrome
SCD
sudden cardiac death

Cited by (0)

Dr. Behr has received research funds from Biotronik and St. Jude Medical; and fellowship support from McColl's Retail Group. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Sharma and Sheppard are joint senior authors.

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