Sudden cardiac death in young athletes

Area of Science:

• Cardiology
• Sports Medicine
• Genetics

Background:

• Athletic activity poses a risk of sudden death for individuals with congenital or acquired heart disorders.
• Young athletes (<35 years) are particularly vulnerable to sudden cardiac death due to inherited conditions like hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, long QT-syndrome, and Marfan's syndrome.

Purpose of the Study:

• To review causes of sudden cardiac death in young athletes.
• To evaluate the effectiveness of screening strategies for identifying at-risk individuals.
• To provide recommendations for preparticipation screening protocols.

Main Methods:

• Review of literature on sudden cardiac death in athletes.
• Analysis of screening protocols, including cascade-screening and preparticipation ECGs.
• Examination of data from Italy and Sweden regarding screening effectiveness.

Main Results:

• Autosomal dominant inherited diseases are the primary cause of sudden cardiac death in athletes under 35.
• Early cascade-screening of relatives and regulated preparticipation screening (e.g., Italy's protocol) can detect at-risk individuals and reduce mortality.
• ECG screening as part of preparticipation evaluations is recommended, with careful criteria to minimize false positives.

Conclusions:

• Implementing comprehensive screening strategies, including cascade-screening and appropriate ECG criteria, is crucial for preventing sudden cardiac death in athletes.
• Less formal systems involving family screening, coach education, and questionnaires show promise, especially for junior athletes.
• Further research is needed to refine ECG screening criteria and understand false-positive/negative rates.