Sports-related sudden cardiac death is reduced by pre-participation cardiovascular screening

August 31, 2008

Young competitive athletes are perceived by the general population to be the healthiest members of society. The possibility that highly trained athletes may have a potentially serious cardiac condition that can predispose to life-threatening tachyarrhythmias or sudden cardiac death seems paradoxical. However, high-risk ventricular tachyarrhythmias and sudden cardiac death in the athlete although uncommon, are extremely visible events due to the high profile of elite and professional athletes. In athletes under the age of 35 years, the incidence of sudden death is low and in most cases occurs in individuals with inherited heart disease, such as hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia and congenital anomalies of coronary arteries. In older athletes, sudden death is more common and is generally due to arrhythmias in the context of coronary artery disease.

A crucial point is the role played by physical exercise and training in the genesis of ventricular arrhythmias and, therefore, whether exercise can enhance the risk of arrhythmic cardiac arrest in athletes. Indeed, regular exercise training is associated with morphologic and functional cardiac changes that may create ambiguity with cardiac pathologic conditions and differentiating the benign, exercise-induced physiologic changes from true pathological conditions with risk of sudden death is critical to developing appropriate screening strategies to reduce such adverse events.

Recent studies showed that the risk for sudden death in young competitive athletes with cardiovascular disease was 2.5-fold greater than in non-athletes. These data suggest that sports activity itself may act as a trigger for life-threatening ventricular tachyarrhythmias in susceptible individuals with underlying, even silent cardiovascular disease, thereby predisposing to cardiac arrest. Therefore, polymorphic and malignant ventricular tachycardia triggered by intensive athletic conditioning should raise suspicion and greater scrutiny for an underlying inherited electrophysiological disorder (such as channelopathies), or an underlying structural disease (like arrhythmogenic right ventricular dysplasia or hypertrophic cardiomyopathy). These findings are in agreement with results of our previous study on physical de conditioning, in which we observed that none of the athletes with frequent and complex ventricular arrhythmias (with or without cardiovascular abnormalities) disqualified from training and competition, experienced clinical events or cardiac arrest in the follow-up and all showed a marked reduction, or even disappearance of the premature ventricular depolarizations.

Therefore, the reduction/disappearance of ventricular arrhythmias is a potential mechanism by which disqualification from competitive sports may reduce the risk for sudden cardiac death. These data support the restriction from competitive sport and intense exercise training in athletes with frequent and complex ventricular arrhythmias and structural heart disease and explains the 89% decline in the incidence rate of sudden cardiovascular death among young competitive athletes aged 12 to 35 years in the Veneto region of Italy over a 26-year period.

These data support the conclusion that the reduction in the incidence of sudden cardiovascular death is the result of the introduction in 1982 of a nationwide pre participation screening program. There was coincident timing between decline of sudden cardiovascular death in young competitive athletes and implementation of pre participation cardiovascular screening in Italy. Athletes with cardiovascular abnormalities need a thorough clinical assessment and therapeutic options for sudden cardiac death prevention, such as ICD. However, in athletes with documented malignant ventricular tachyarrhythmias, competitive sports are contraindicated. A possible exception is represented by ventricular arrhythmias occurring in the context of acute and transient myocardial lesion, such as myocarditis, commotio cordis, acute electrolytic depletion, when the cause has proven to be completely resolved.

European Society of Cardiology

Related Cardiovascular Disease Articles from Brightsurf:

Changes by income level in cardiovascular disease in US
Researchers examined changes in how common cardiovascular disease was in the highest-income earners compared with the rest of the population in the United States between 1999 and 2016.

Fighting cardiovascular disease with acne drug
Researchers from the European Molecular Biology Laboratory (EMBL) in Heidelberg and Stanford University have found the cause of dilated cardiomyopathy - a leading cause of heart failure - and identified a potential treatment for it: a drug already used to treat acne.

A talk with your GP may prevent cardiovascular disease
Having a general practitioner (GP) who is trained in motivational interviewing may reduce your risk of getting cardiovascular disease.

Dilemma of COVID-19, aging and cardiovascular disease
Whether individuals should continue to take angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in the context of coronavirus disease 2019 (COVID-19) is discussed in this article.

Air pollution linked to dementia and cardiovascular disease
People continuously exposed to air pollution are at increased risk of dementia, especially if they also suffer from cardiovascular diseases, according to a study at Karolinska Institutet in Sweden published in the journal JAMA Neurology.

New insights into the effect of aging on cardiovascular disease
Aging adults are more likely to have - and die from - cardiovascular disease than their younger counterparts.

Premature death from cardiovascular disease
National data were used to examine changes from 2000 to 2015 in premature death (ages 25 to 64) from cardiovascular disease in the United States.

Ultrasound: The potential power for cardiovascular disease therapy
In the current issue of Cardiovascular Innovations and Applications volume 4, issue 2, pp.

Despite the ACA, millions of Americans with cardiovascular disease still can't get care
Cardiovascular disease (CVD) is the leading cause of death for Americans, yet millions with CVD or cardiovascular risk factors (CVRF) still can't access the care they need, even years after the implementation of the Affordable Care Act (ACA).

Excess weight and body fat cause cardiovascular disease
In the first Mendelian randomization study to look at this, researchers have found evidence that excess weight and body fat cause a range of heart and blood vessel diseases (rather than just being associated with it).

Read More: Cardiovascular Disease News and Cardiovascular Disease Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to