Herz Kardiovaskuläre Erkrankungen

, Volume 34, Issue 4, pp 259–266 | Cite as

Sudden cardiac death in athletes

Can it be prevented by screening?
  • Domenico Corrado
  • Federico Migliore
  • Michela Bevilacqua
  • Cristina Basso
  • Gaetano Thiene
Article

Abstract

In 1982, a nationwide program of preparticipation screening of all individuals embarking in competitive sports activity was launched in Italy. The screening protocol includes athlete’s personal and family history, physical examination, and twelve-lead electrocardiogram (ECG) as first-line examination; additional tests such as echocardiography or exercise testing are requested only for subjects who have positive findings at the initial evaluation. This screening algorithm, which has been used for preparticipation evaluation of millions of Italian athletes over a period of > 25 years has provided adequate sensitivity and specificity for detection of athletes affected by potentially dangerous cardiomyopathy or arrhythmia at risk of athletic-field death and has led to substantial reduction of mortality of young competitive athletes (by approximately 90%), mostly by preventing sudden death from cardiomyopathy.

Key Words:

Cardiomyopathy ECG Sports cardiology Sudden cardiac death 

Plötzlicher Herztod bei Athleten. Kann er durch Vorsorgeuntersuchungen verhindert werden?

Zusammenfassung

1982 wurde in Italien ein nationales Programm mit dem Ziel eingeführt, alle Individuen, die mit Wettkampfsport beginnen, einer medizinischen Vorsorgeuntersuchung zu unterziehen. Dieses Vorsorgeprotokoll beinhaltet als Basisuntersuchung die persönliche und familiäre Anamnese des Athleten, eine körperliche Untersuchung sowie ein Zwölf-Kanal-EKG; bei positiven Befunden werden weitere Untersuchungen vorgenommen, etwa eine Echokardiographie oder ein Belastungstest. Der Screeningalgorithmus, der seit > 25 Jahren bei Millionen Italienern angewandt wird, hat eine ausreichende Sensitivität und Spezifität gezeigt, um Sportler detektieren zu können, die aufgrund einer Kardiomyopathie oder von Rhythmusstörungen ein erhöhtes Risiko aufweisen, auf dem Wettkampfplatz zu versterben. Das Vorsorgeprogramm hat zu einer substantiellen Reduktion (um ca. 90%) von Todesfällen bei jungen Wettkampfsportlern geführt, insbesondere durch Verhinderung eines plötzlichen Herztods aufgrund einer Kardiomyopathie.

Schlüsselwörter:

Kardiomyopathie EKG Sportkardiologie Plötzlicher Herztod 

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References

  1. 1.
    Maron BJ. Sudden death in young athletes. N Engl J Med 2003;349:1064–75.PubMedCrossRefGoogle Scholar
  2. 2.
    Corrado D, Basso C, Thiene G. Assay: sudden death in young athletes. Lancet 2005;366:Suppl I:47–8.CrossRefGoogle Scholar
  3. 3.
    Corrado D, Basso C, Schiavon M, et al. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med 1998;339:364–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Corrado D, Pelliccia A, Bjørnstad HH, et al. Cardiovascular preparticipation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 2005;26:516–24.PubMedCrossRefGoogle Scholar
  5. 5.
    Van Camp SP, Bloor CM, Mueller FO, et al. Non-traumatic sports death in high school and college athletes. Med Sci Sports Exerc 1995;27:641–7.PubMedGoogle Scholar
  6. 6.
    Corrado D, Basso C, Rizzoli G, et al. Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol 2003;42:1959–63.PubMedCrossRefGoogle Scholar
  7. 7.
    Burke AP, Farb A, Virmani R, et al. Sports-related and non-sports-realted sudden cardiac death in young adults. Am Heart J 1991;121:568–75.PubMedCrossRefGoogle Scholar
  8. 8.
    Wilson JMG, Jungner G. Principles and practice of screening for diseases. Geneva: WHO, 1968.Google Scholar
  9. 9.
    Thompson PD, Funk EJ, Carleton RA, et al. Incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA 1982;247:2535–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Thompson PD, Franklin BA, Balady GJ, et al., American Heart Association Council on Nutrition, Physical Activity, and Metabolism, American Heart Association Council on Clinical Cardiology, American College of Sports Medicine. Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation 2007;115:2358–68.PubMedCrossRefGoogle Scholar
  11. 11.
    Corrado D, Migliore F, Basso C, et al. Exercise and the risk of sudden cardiac death. Herz 2006;31:553–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Maron BJ. The paradox of exercise. N Engl J Med 2000;343: 1409–11.PubMedCrossRefGoogle Scholar
  13. 13.
    Corrado D, Pelliccia A, Antzelevitch C, et al. ST segment elevation and sudden death in the athlete. In: Antzelevitch C, ed. The Brugada syndrome: from bench to bedside. Oxford: Blackwell Futura, 2005:119–29.CrossRefGoogle Scholar
  14. 14.
    Maron BJ, Gohman TE, Kyle SB, et al. Clinical profile and spectrum of commotio cordis. JAMA 2002;287:1142–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Maron BJ, Thompson PD, Ackerman MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update. A scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 2007;115:1643–55.PubMedCrossRefGoogle Scholar
  16. 16.
    Glower DW, Maron BJ. Profile of preparticipation cardiovascular screening for high school athletes. JAMA 1998;279: 1817–9.CrossRefGoogle Scholar
  17. 17.
    Pelliccia A, Di Paolo FM, Corrado D, et al. Evidence for efficacy of the Italian national pre-participation screening programme for identification of hypertrophic cardiomyopathy in competitive athletes. Eur Heart J 2006;27:2196–200.PubMedCrossRefGoogle Scholar
  18. 18.
    Corrado D, Basso C, Pavei A, et al. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 2006;296:1593–601.PubMedCrossRefGoogle Scholar
  19. 19.
    Maron BJ, Pelliccia A. The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation 2006;114:1633–44.PubMedCrossRefGoogle Scholar
  20. 20.
    Pelliccia A, Maron BJ, Culasso F, et al. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 2000;102:278–84.PubMedGoogle Scholar
  21. 21.
    Corrado D, McKenna WJ. Appropriate interpretation of the athlete’s electrocardiogram saves lives as well as money. Eur Heart J 2007;28:1920–2.PubMedCrossRefGoogle Scholar
  22. 22.
    Melacini P, Cianfrocca C, Calore C, et al. Marginal overlap between EGC abnormalities in patients with hypertrophic cardiomyopathy and trained athletes: implications for preparticipation screening. Circulation 2007;116:Suppl II:765. abstract.Google Scholar
  23. 23.
    Sharma S, Whyte G, Elliott P, et al. Electrocardiographic changes in 1000 highly trained junior elite athletes. Br J Sports Med 1999;33:319–24.PubMedCrossRefGoogle Scholar
  24. 24.
    Douglas PS, O’Toole ML, Hiller WDB, et al. Electrocardiographic diagnosis of exercise-induced left ventricular hypertrophy. Am Heart J 1988;116:784–90.PubMedCrossRefGoogle Scholar
  25. 25.
    Marcus FI. Prevalence of T-wave inversion beyond V1 in young normal individuals and usefulness for the diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia. Am J Cardiol 2005;95:1070–1.PubMedCrossRefGoogle Scholar
  26. 26.
    Corrado D, Michieli P, Schiavon M, et al. Prevalence and clinical significance of right precordial T-wave inversion at electrocardiographic preparticipation screening: a prospective study on 3086 young competitive athletes. Circulation 2007;116:Suppl II:339.abstract.Google Scholar
  27. 27.
    Corrado D, Basso C, Schiavon M, et al. Pre-participation screening of young competitive athletes for prevention of sudden cardiac death. J Am Coll Cardiol 2008;52:1981–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Myerburg RJ, Vetter VL. Electrocardiograms should be included in preparticipation screening of athletes. Circulation 2007;116:2616–26.PubMedCrossRefGoogle Scholar
  29. 29.
    Maron BJ, Zipes DP. 36th Bethesda Conference: recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities: J Am Coll Cardiol 2005;45:1373–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Pelliccia A, Fagard R, Bjornstad HH, et al. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 2005;26:1422–45.PubMedCrossRefGoogle Scholar
  31. 31.
    Drezner JA, Rogers KJ. Sudden cardiac arrest in intercollegiate athletes: detailed analysis and outcomes of resuscitation in nine cases. Heart Rhythm 2006;3:755–9.PubMedCrossRefGoogle Scholar

Copyright information

© Urban & Vogel, Muenchen 2009

Authors and Affiliations

  • Domenico Corrado
    • 1
    • 3
  • Federico Migliore
    • 1
  • Michela Bevilacqua
    • 1
  • Cristina Basso
    • 2
  • Gaetano Thiene
    • 2
  1. 1.Division of Cardiology, Department of Cardiac, Thoracic and Vascular SciencesUniversity of PaduaPadovaItaly
  2. 2.Cardiovascular Pathology, Department of Medical-Diagnostic SciencesUniversity of PaduaPadovaItaly
  3. 3.Department of Cardiac, Thoracic and Vascular SciencesUniversity of Padua, Medical SchoolPadovaItaly

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