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Sudden cardiac death in Athletes

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Abstract

The impact of sudden cardiac death (SCD) in athletes has been highlighted by increasing media coverage, as well as medical and lay awareness of the entities associated with SCD. Common etiologies include cardiac abnormalities such as hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD), and coronary artery anomalies, each with varying geographic incidence. New recommendations regarding noninvasive preparticipation screening have emerged in Europe, where the Italian experience of mandatory annual screening of athletes has been the forerunner in efforts to identify individuals at risk. Ongoing clinical efforts are underway to help define the role of implantable cardioverter defibrillators as a preventive measure in appropriate candidates with HCM or ARVD, as well as methods to limit the potential for SCD as a result of chest blows sustained in sports and other recreational activities by means of chest protectors and special sporting equipment for young athletes.

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References and Recommended Reading

  1. Maron BJ, Shirani J, Poliac LC, et al.: Sudden death in young competitive athletes: clinical, demographic, and pathological profiles. JAMA 1996, 276:199–204.

    Article  PubMed  CAS  Google Scholar 

  2. Maron BJ: Sudden death in young athletes. N Engl J Med 2003, 349:1064–1075. Seminal article describing etiology of SCD in 387 young athletes. Autopsy data obtained from the Minneapolis Heart Institute Foundation.

    Article  PubMed  CAS  Google Scholar 

  3. Maron BJ: Sudden death in young athletes: lessons from the Hank Gaithers affair. N Engl J Med 1993, 329:55–57.

    Article  PubMed  CAS  Google Scholar 

  4. Maron BJ: How should we screen competitive athletes for cardiovascular disease? Eur Heart J 2005, 26:428–430.

    Article  PubMed  Google Scholar 

  5. Maron BJ, Chaitman BR, Ackerman MJ, et al.:Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation 2004, 109:2807–2816. Recommendations for recreational exercise in patients with known genetic cardiovascular diseases, including HCM, ARVD, Marfan syndrome, and ion channelopathies.

    Article  PubMed  Google Scholar 

  6. Corrado D, Pelliccia A, Bjornstad HH, et al.: Cardiovascular pre-participation 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, 26:516–524. ESC guidelines for SCD prevention in competitive athletes. Central to these recommendations are preparticipation screening, history, and physical examination, and 12-lead ECG.

    Article  PubMed  Google Scholar 

  7. Maron BJ, Zipes DP: 36th Bethesda Conference: eligibility recommendations for competitive athletes with cardiovascular abnormalities. J Am Coll Cardiol 2005, 45:1318–1321. Updated Bethesda guidelines dealing in detail with athletes with a range of identified cardiac abnormalities, and providing broad consensus statements on issues such as HCM, ARVD, and coronary anomalies. Guidance is also given regarding commotio cordis, as well as medicolegal questions surrounding this issue.

    Article  PubMed  Google Scholar 

  8. Maron BJ, Gohman TE, Aeppli D: Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes. J Am Coll Cardiol 1998, 32:1881–1884.

    Article  PubMed  CAS  Google Scholar 

  9. 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, 42:1959–1963.

    Article  PubMed  Google Scholar 

  10. Pelliccia A, Maron BJ: Pre-participation cardiovascular evaluation of the competitive athlete: perspectives from the 30-year Italian experience. Am J Cardiol 1995, 75:827–829.

    Article  PubMed  CAS  Google Scholar 

  11. Williams RG, Chen AY: Identifying athletes at risk for sudden death. J Am Coll Cardiol 2003, 42:1964–1966.

    Article  PubMed  Google Scholar 

  12. Maron BJ, Carney KP, Lever HM, et al.: Relationship of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy. J Am Coll Cardiol 2003, 41:974–980.

    Article  PubMed  Google Scholar 

  13. Di Diego JM, Cordeiro JM, Goodrow RJ, et al.: Ionic and cellular basis for the predominance of the Brugada syndrome phenotype in males. Circulation 2002, 102:2004–2011.

    Article  Google Scholar 

  14. Whang W, Manson JE, Hu FB, et al.: Physical exertion, exercise, and sudden cardiac death in women. JAMA 2006, 295:1399–1403. An updated analysis of the Nurses’ Health Study data from the perspective of identifying trends in SCD in women. The data suggest that SCD during exertion is an extremely rare event in women. Regular exercise may significantly minimize this transient risk and may lower the overall long-term risk of SCD.

    Article  PubMed  CAS  Google Scholar 

  15. Roberts WO, Maron BJ: Evidence for decreasing occurrence of sudden cardiac death associated with the marathon. J Am Coll Cardiol 2005, 46:1373–1374.

    Article  PubMed  Google Scholar 

  16. Maron BJ, Poliac LC, Roberts WO: Risk for sudden cardiac death associated with marathon running. J Am Coll Cardiol 1996, 28:428–431.

    Article  PubMed  CAS  Google Scholar 

  17. Coris EE, Miller E, Sahebzamani F: Sudden cardiac death in division I collegiate athletics: analysis of automated external defibrillator utilization in National Collegiate Athletic Association division I athletic programs. Clin J Sport Med 2005, 15:87–91.

    Article  PubMed  Google Scholar 

  18. Thiene G, Nava A, Corrado D, et al.: Right ventricular cardiomyopathy and sudden death in young people. N Engl J Med 1988, 318:129–133.

    Article  PubMed  CAS  Google Scholar 

  19. Maron BJ: Contemporary considerations for risk stratification, sudden death and prevention in hypertrophic cardiomyopathy. Heart 2003, 89:977–978.

    Article  PubMed  CAS  Google Scholar 

  20. Basso C, Thiene G, Corrado D, et al.: Arrhythmogenic right ventricular cardiomyopathy: dysplasia, dystrophy, or myocarditis? Circulation 1996, 94:983–991.

    PubMed  CAS  Google Scholar 

  21. Corrado D, Basso C, Thiene G: Arrhythmogenic right ventricular cardiomyopathy: diagnosis, prognosis, and treatment. Heart 2000, 83:588–595.

    Article  PubMed  CAS  Google Scholar 

  22. Hulot JS, Jouven X, Empana JP, et al.: Natural history and risk stratification of arrhythmogenic right ventricular dysplasia/cardiomyopathy. Circulation 2004, 110:1879–1884.

    Article  PubMed  Google Scholar 

  23. Lemola K, Brunckhorst C, Helfenstein U, et al.: Predictors of adverse outcome in patients with arrhythmogenic right ventricular dysplasia / cardiomyopathy: long term experience of a tertiary care centre. Heart 2005, 91:1167–1172.

    Article  PubMed  CAS  Google Scholar 

  24. Corrado D, Leoni L, Link MS, et al.: Implantable cardioverter-defibrillator therapy for prevention of sudden death in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation 2003, 108:3084 -3091.

    Article  PubMed  Google Scholar 

  25. Link MS, Wang PJ, Haugh CJ, et al.: Arrhythmogenic right ventricular dysplasia: clinical results with implantable cardioverter Defibrillators. J Intervent Cardiol Electrophysiol 1997, 1:41–48.

    Article  CAS  Google Scholar 

  26. Tavernier R, Gevaert S, De Sutter J, et al.: Long term results of cardioverter-defibrillator implantation in patients with right ventricular dysplasia and malignant ventricular tachyarrhythmias. Heart 2001, 85:53–56.

    Article  PubMed  CAS  Google Scholar 

  27. Roguin A, Bomma C, Nasir K, et al.: Implantable cardioverter- defibrillators in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy. J Am Coll Cardiol 2004, 43:1843–1852.

    Article  PubMed  Google Scholar 

  28. Wichter T, Paul M, Wollmann C, et al.: Implantable cardioverter/defibrillator therapy in arrhythmogenic right ventricular cardiomyopathy. Single-center experience of long-term follow-up and complications in 60 patients. Circulation 2004, 109:1503–1508.

    Article  PubMed  Google Scholar 

  29. Eckart RE, Scoville SL, Campbell CL, et al.: Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med 2004, 141:829–834.

    PubMed  Google Scholar 

  30. Basso C, Maron BJ, Corrado D, Thiene G: Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2001, 35:1493–1501.

    Article  Google Scholar 

  31. Maron BJ, Poliac LC, Kaplan JA, Mueller FO: Blunt impact to the chest leading to sudden death from cardiac arrest during sports activities. N Engl J Med 1995, 333:337–342.

    Article  PubMed  CAS  Google Scholar 

  32. Maron BJ, Gohman TE, Kyle SB, et al.: Clinical profile and spectrum of commotio cordis. JAMA 2002, 287:1142–1146.

    Article  PubMed  Google Scholar 

  33. Link MS, Wang PJ, Pandian NG, et al.: An experimental model of sudden death due to low-energy chest-wall impact (commotio cordis). N Engl J Med 1998, 338:1805–1811.

    Article  PubMed  CAS  Google Scholar 

  34. Link MS, Maron BJ, VanderBrink BA, et al.: Impact directly over the cardiac silhouette is necessary to produce ventricular fibrillation in an experimental model of commotio cordis. J Am Coll Cardiol 2001, 37:649–654.

    Article  PubMed  CAS  Google Scholar 

  35. Link MS, Maron BJ, Wang PJ: Upper and lower limits of vulnerability to sudden arrhythmic death with chest wall impact (commotio cordis). J Am Coll Cardiol 2003, 41:99–104.

    Article  PubMed  Google Scholar 

  36. Link MS, Maron BJ, Wang PJ, et al.: Reduced risk of sudden death from chest wall blows (commotio cordis) with safety baseballs. Pediatrics 2002, 109:873–877.

    Article  PubMed  Google Scholar 

  37. Weinstock J, Maron BJ, Song C, et al.: Failure of commercially available chest wall protectors to prevent sudden cardiac death induced by chest wall blows in an experimental model of commotio cordis. Pediatrics 2006, 117:e656-e662.

    Article  PubMed  Google Scholar 

  38. Maron BJ, Estes NAM III, Link MS: Task Force 11: commotio cordis. J Am Coll Cardiol 2005, 45:1371–1373.

    Article  PubMed  Google Scholar 

  39. Hedrich O, Link MS, Homoud MK, Estes NAM III:Syncope in the athlete. In Syncope: Mechanisms and Management, edn 2. Edited by Grubb BP, Olshansky B. Bostona: Blackwell Futura; 2005:287–300.

    Google Scholar 

  40. Maron BJ, Roberts WC, McCallister WA, et al.: Sudden death in young athletes. Circulation 1980, 62:218–229.

    PubMed  CAS  Google Scholar 

  41. Pelliccia A, Maron BJ, Spataro A, et al.: The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med 1991, 324:295–301.

    Article  PubMed  CAS  Google Scholar 

  42. Sharma S, Maron BJ, Whyte G, et al.: Physiologic limits of left ventricular hypertrophy in elite junior athletes: relevance to differential diagnosis of athlete’s heart and hypertrophic cardiomyopathy. J Am Coll Cardiol 2002, 40:1431–1436.

    Article  PubMed  Google Scholar 

  43. Abernethy WB III, Choo JK, Hutter HM: Echocardiographic characteristics of professional football players. J Am Coll Cardiol 2003, 41:280–284.

    Article  PubMed  Google Scholar 

  44. Maron BJ: Distinguishing hypertrophic cardiomyopathy from athlete’s heart: a clinical problem of increasing magnitude and significance. Heart 2005, 91:1380–1382. An updated editorial considering this important clinical question. Because there is presently no single testing approach available that will definitively resolve this question in all athletes, several noninvasive strategies have evolved; several are described here, including genetic testing, cavity dimension, and LV filling patterns. The influence of sex and type of sport are also considered.

    Article  PubMed  CAS  Google Scholar 

  45. Maron BJ, Pelliccia A, Spirito P: Cardiac disease in young trained athletes. Insights into methods for distinguishing athlete’s heart from structural heart disease, with particular emphasis on hypertrophic cardiomyopathy. Circulation 1995, 91:1596–1601.

    PubMed  CAS  Google Scholar 

  46. Pelliccia A, Maron BJ, Spataro A, et al.: Absence of left ventricular hypertrophy in athletes engaged in intense power training. Am J Cardiol 1993, 72:1048–1054.

    Article  PubMed  CAS  Google Scholar 

  47. Scharhag J, Schneider G, Urhausen A, et al.: Athlete’s heart: right and left ventricular mass and function in male endurance athletes and untrained individuals determined by magnetic resonance imaging. J Am Coll Cardiol 2002, 40:1856–1863.

    Article  PubMed  Google Scholar 

  48. Maron BJ, Seidman JG, Seidman CE: Proposal for contemporary screening strategies in families with familial hypertrophic cardiomyopathy. J Am Coll Cardiol 2004, 44:2125–2132.

    Article  PubMed  Google Scholar 

  49. Anastasakis A, Kotsiopoulou C, Rigopoulos A, et al.:Similarities in the profile of cardiopulmonary exercise testing between patients with hypertrophic cardiomyopathy and strength athletes. Heart 2005, 91:1477–1478.

    Article  PubMed  CAS  Google Scholar 

  50. Bif. A, Maron BJ, Verdile L, et al.: Impact of physical deconditioning on ventricular tachyarrhythmias in trained athletes. J Am Coll Cardiol 2004, 44:1053–1058.

    Article  Google Scholar 

  51. Soejima K, Stevenson WG: Athens, athletes, and arrhythmias: the cardiologist’s dilemma. J Am Coll Cardiol 2004, 44:1059–1061.

    Article  PubMed  Google Scholar 

  52. Decree of the Italian Ministry of Health, 18 February 1982. Norme per la tutela sanitaria dell’attivita sportive agnostica (rules concerning the medical protection of athletic activity). Gazzetta Ufficiale 1982, 5(March):63.

    Google Scholar 

  53. Pfister GC, Puffer JC, Maron BJ: Pre-participation cardiovascular screening for US collegiate student-athletes. JAMA 2000, 283:1597–1599.

    Article  PubMed  CAS  Google Scholar 

  54. Paterick TE, Paterick TJ, Fletcher GF, Maron BJ: Medical and legal issued in the cardiovascular evaluation of competitive athletes. JAMA 2005, 294:3011–3018.

    Article  PubMed  CAS  Google Scholar 

  55. Fuller CM: Cost effectiveness analysis of screening of high school athletes for risk of sudden cardiac death. Med Sci Sport Exerc 2000, 32:887–890.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, Tufts-New England Medical Center, Cardiac Arrhythmia Service, 750 Washington Street, Box #197, 02111, Boston, MA, USA

    Mark S. Link MD

Authors
  1. Olaf Hedrich MD, N.A.
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  2. Mark Estes III MD
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  3. Mark S. Link MD
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Correspondence to Mark S. Link MD.

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Hedrich, O., Estes, M. & Link, M.S. Sudden cardiac death in Athletes. Curr Cardiol Rep 8, 316–322 (2006). https://doi.org/10.1007/s11886-006-0069-z

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