Sudden Cardiac Death in Athletes: Current Knowledge and Newer Concepts

Sudden Cardiac Death (SCD) is a rare but devastating event for the athlete's family and for the community and occurs most often during sport activity. The prevalence of SCD ranges from 1 per 50,000 to 1 per 200,000 athletes per year. The risk seems higher in the athletes than in the non-athlete population, higher in men than in women and higher in competitive athletes than in non-professional athletes. The mechanisms of SCD was believed until recently to be the result of interactions of an underlying undetected heart disease with a number of acute and transient triggering factors. In athletes over 35 years of age, coronary artery disease is the dominant cause. In athletes younger than 35 years, congenital anomalies, inherited syndromes related to channelopathies are common associated conditions. Recently experimental evidence and clinical observations lead to believe that heavy and prolonged exercise may induce changes primarily in the right ventricular structure that mimic the familial arrhythmogenic right ventricular cardiomyopathy. The origin of these changes could not be ascribed to a genetic predisposition only and requires further investigation Preparticipation screening of athletes at risk and its cost-effectiveness is still the subject of debate because of the lack of evidence-based data. Detection of athletes at risk implies for detected individuals restriction regarding sports practice or /and competition. Despite these limitations, several scientific societies from both sides of the Atlantic have issued guidelines on the recommended work-up for detecting athletes at risk of SCD and on sports restriction which are discussed here.