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Medicina
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Sudden Cardiac Death in Athletes
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Sudden Cardiac Death in Athletes

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 January 2021) | Viewed by 28961

Special Issue Editors

Prof. Dr. Michela Casella

E-Mail Website
Guest Editor
Cardiology and Arrhythmology Clinic, Department of Clinical, Special and Dental Sciences, University Hospital “Umberto I-Lancisi-Salesi”, Marche Polytechnic University, Ancona, Italy
Interests: cardiac arrhythmias; cardiomyopathies; catheter ablation; ventricular arrhythmias; endomyocardial biopsy
Prof. Dr. Antonio Dello Russo

E-Mail Website
Guest Editor
Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital “Umberto I-Lancisi-Salesi”. Marche Polytechnic University, Ancona, Italy
Interests: cardiac arrhythmias; cardiomyopathies; catheter ablation; ventricular arrhythmias; endomyocardial biopsy

Special Issue Information

Dear Colleagues,

After recent dramatic reports of sports-related sudden cardiac deaths, the sports eligibility assessment of athletes has generated consistent uncertainties and preoccupation. Sudden cardiac death occurs in approximately 1 per 200,000 young athletes per year, usually triggered during competition or practice. It remains a difficult medical challenge to prevent this dramatic event. Most causes relate to congenital or acquired cardiovascular disease, with no symptoms noted before the fatal event. The most frequent causes of sudden cardiac death in this young population are: hypertrophic cardiomyopathy, coronary artery anomalies, myocarditis, arrhythmogenic right ventricular cardiomyopathy, and channelopathies. The prevalence of any single associated condition is low, and the sensitivity and specificity of common screening tests leave much to be desired. The single most important predictor is fainting or near-fainting during exercise caused by ventricular arrhythmias. Some forms of ventricular arrhythmias are common in athletes, and may be considered a feature of the athlete’s heart adaptive phenotype. On the other hand, ventricular arrhythmias may also represent the main clinical clue to a concealed cardiomyopathy, potentially heralding sudden cardiac death during sports activity. Currently, there is no consensus on how far the investigations should go in order to avoid missing important diagnoses in athletes at risk of sudden cardiac death. According to an extensive diagnostic workup, the identification of high-risk athletes raises the question of sport eligibility, the need and type of ICD implant, and the safety of returning to practice in ICD wearers.

The purpose of this Special Issue is to discuss issues associated with sudden cardiac death in athletes, with a focus on diagnostic workup, invasive and non-invasive diagnostic approaches, and finally, therapeutic options that provide a framework for decision making in this difficult scenario.

Prof. Dr. Michela Casella
Prof. Dr. Antonio Dello Russo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • sudden cardiac death
  • athletes
  • ventricular arrhythmias
  • hypertrophic cardiomyopathy
  • coronary artery anomalies
  • myocarditis
  • arrhythmogenic right ventricular cardiomyopathy
  • channelopathies
  • ICD implant

Published Papers (10 papers)

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Research

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9 pages, 459 KiB  
Article
Epidemiology of Football-Related Sudden Cardiac Death in Turkey
by Ali Işın, Adnan Turgut and Amy E. Peden
Medicina 2021, 57(10), 1105; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57101105 - 14 Oct 2021
Cited by 1 | Viewed by 3404
Abstract
Background and Objectives: Sudden cardiac death (SCD), particular among elite footballers, has attracted much attention in recent times. However, limited information exists on football-related SCD in Turkey. Autopsy-based studies of sports-related sudden deaths in Turkey are rare and often have small sample [...] Read more.
Background and Objectives: Sudden cardiac death (SCD), particular among elite footballers, has attracted much attention in recent times. However, limited information exists on football-related SCD in Turkey. Autopsy-based studies of sports-related sudden deaths in Turkey are rare and often have small sample sizes. To address this, this study aimed to determine the population-based incidence and profile of football-related SCD nationally in Turkey. Materials and Methods: Due to a lack of national data on this issue, football-related SCD (non-elite competitive or recreational football) between 1 January 2011, and 31 December 2019 were identified by dual, independent identification and screening of online media reports. Deaths were explored by sex, age group, season, and phase of exercise. Descriptive statistics were utilised. Age-specific mortality rates and proportional mortality rates were calculated. Results: In total, 118 football-related SCD were identified, a crude mortality rate of 0.41 per 100,000 population. All fatalities were males and the mean age was 35.5 years ± 10.4. Those aged 40–49 years recorded the highest mortality rate (0.67/100,000), three times the risk of those aged 50–59 years (RR = 3.1; 95%CI:1.5–6.4). Those aged 30–39 recorded the highest age-specific proportional mortality rate (0.86/1000 deaths). The highest risk occurred while playing football (n = 97; 82.2%), with another 15% of deaths (n = 18) occurring within 1 h of play. Almost all fatalities (n = 113; 95.8%) occurred during participation in recreational football. Conclusions: This study has identified football-related SCD most commonly occurs during recreational football among males aged 30–49 years. It is recommended males of this age participating in recreational football be encouraged to seek pre-participation heart health checks. Given the value of automated external defibrillators (AEDs) in responding to out-of-hospital cardiac arrest, future research should explore the feasibility and effectiveness of AEDs in preventing football-related SCD in Turkey including training of first responders in cardiopulmonary resuscitation and AED use. Full article
(This article belongs to the Special Issue Sudden Cardiac Death in Athletes)
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8 pages, 1841 KiB  
Article
Ventricular Fibrillation Recurrences in Successfully Shocked Out-of-Hospital Cardiac Arrests
by Daniela Aschieri, Federico Guerra, Valentina Pelizzoni, Enrico Paolini, Giulia Stronati, Luca Moderato, Giulia Losi, Paolo Compagnucci, Michela Coccia, Michela Casella, Antonio Dello Russo, Gust H. Bardy and Alessandro Capucci
Medicina 2021, 57(4), 358; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57040358 - 07 Apr 2021
Cited by 1 | Viewed by 2176
Abstract
Background and Objectives: The prognostic impact of ventricular fibrillation (VF) recurrences after a successful shock in out-of-hospital cardiac arrest (OOHCA) is still poorly understood, and some evidence suggests a potential pro-arrhythmic effect of chest compressions in this setting. In the present analysis, we [...] Read more.
Background and Objectives: The prognostic impact of ventricular fibrillation (VF) recurrences after a successful shock in out-of-hospital cardiac arrest (OOHCA) is still poorly understood, and some evidence suggests a potential pro-arrhythmic effect of chest compressions in this setting. In the present analysis, we looked at the short-term and long-term prognosis of VF recurrences in OOHCA. And their potential association with chest compressions. Materials and Methods: The Progetto Vita, prospectively collecting data on all resuscitation efforts in the Piacenza province (Italy), was used for the present analysis. From the 461 OOHCAs found in a shockable rhythm, only those with optimal ECG tracings and good audio recordings (160) were assessed. Rhythms other than VF post-shock were analyzed five seconds after shock delivery and survival to hospital admission, hospital discharge, and long-term survival data over a 14-year follow-up were collected. Results: Population mean age was 64.4 ± 16.9 years, and 31.9% of all patients were female. Mean time to EMS arrival was 5.9 ± 4.5 min. Short- and long-term survival without neurological impairment were higher in patients without VF recurrence when compared to patients with VF recurrence, independently from the pre-induction rhythm (p < 0.001). After shock delivery, VF recurrence was higher when chest compressions were resumed early after discharge and more vigorously. Conclusions: VF recurrences after a shock could worsen short and long-term survival. The potential pro-arrhythmic effect of chest compressions should be factored in when considering the real risks and benefits of this procedure. Full article
(This article belongs to the Special Issue Sudden Cardiac Death in Athletes)
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9 pages, 1317 KiB  
Article
Sudden Cardiac Death in Athletes in Italy during 2019: Internet-Based Epidemiological Research
by Fabrizio Sollazzo, Vincenzo Palmieri, Salvatore Francesco Gervasi, Francesco Cuccaro, Gloria Modica, Maria Lucia Narducci, Gemma Pelargonio, Paolo Zeppilli and Massimiliano Bianco
Medicina 2021, 57(1), 61; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57010061 - 12 Jan 2021
Cited by 12 | Viewed by 3835
Abstract
Background and objectives: An Italian nationwide pre-participation screening approach for prevention of sudden cardiac death in athletes (SCD-A) in competitive sportspeople showed promising results but did not achieve international consensus, due to cost-effectiveness and the shortfall of a monitoring plan. From this perspective, [...] Read more.
Background and objectives: An Italian nationwide pre-participation screening approach for prevention of sudden cardiac death in athletes (SCD-A) in competitive sportspeople showed promising results but did not achieve international consensus, due to cost-effectiveness and the shortfall of a monitoring plan. From this perspective, we tried to provide an epidemiological update of SCD-A in Italy through a year-long internet-based search. Materials and Methods: One year-long Google search was performed using mandatory and non-mandatory keywords. Data were collected according to prevalent SCD-A definition and matched with sport-related figures from Italian National Institute of Statistics (ISTAT) and Italian National Olympic Committee (CONI). Results: Ninety-eight cases of SCD-A in 2019 were identified (48.0% competitive, 52.0% non-competitive athletes). Male/female ratio was 13:1. The most common sports were soccer (33.7%), athletics (15.3%) and fitness (13.3%). A conclusive diagnosis was achieved only in 37 cases (33 of cardiac origin), with the leading diagnosis being coronary artery disease in 27 and a notably higher occurrence among master athletes. Combining these findings with ISTAT and CONI data, the SCD-A incidence rate in the whole Italian sport population was found to be 0.47/100,000 persons per year (1.00/100,000 in the competitive and 0.32/100,000 in the non-competitive population). The relative risk of SCD-A is 3.1 (CI 2.1–4.7; p < 0.0001) for competitive compared to non-competitive athletes; 9.9 for male (CI 4.6–21.4; p < 0.0001) with respect to female. Conclusions: We provided an updated incidence rate of SCD-A in both competitive and non-competitive sport in Italy. A higher risk of SCD-A among competitive and male athletes was confirmed, thus corroborating the value of Italian pre-participation screening in this population. Full article
(This article belongs to the Special Issue Sudden Cardiac Death in Athletes)
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Review

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20 pages, 5379 KiB  
Review
Cardiac Imaging in Athlete’s Heart: The Role of the Radiologist
by Marco Fogante, Giacomo Agliata, Maria Chiara Basile, Paolo Compagnucci, Giovanni Volpato, Umberto Falanga, Giulia Stronati, Federico Guerra, Davide Vignale, Antonio Esposito, Antonio Dello Russo, Michela Casella and Andrea Giovagnoni
Medicina 2021, 57(5), 455; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57050455 - 07 May 2021
Cited by 8 | Viewed by 2710
Abstract
Athlete’s heart (AH) is the result of morphological and functional cardiac modifications due to long-lasting athletic training. Athletes can develop very marked structural myocardial changes, which may simulate or cover unknown cardiomyopathies. The differential diagnosis between AH and cardiomyopathy is necessary to prevent [...] Read more.
Athlete’s heart (AH) is the result of morphological and functional cardiac modifications due to long-lasting athletic training. Athletes can develop very marked structural myocardial changes, which may simulate or cover unknown cardiomyopathies. The differential diagnosis between AH and cardiomyopathy is necessary to prevent the risk of catastrophic events, such as sudden cardiac death, but it can be a challenging task. The improvement of the imaging modalities and the introduction of the new technologies in cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) can allow overcoming this challenge. Therefore, the radiologist, specialized in cardiac imaging, could have a pivotal role in the differential diagnosis between structural adaptative changes observed in the AH and pathological anomalies of cardiomyopathies. In this review, we summarize the main CMR and CCT techniques to evaluate the cardiac morphology, function, and tissue characterization, and we analyze the imaging features of the AH and the key differences with the main cardiomyopathies. Full article
(This article belongs to the Special Issue Sudden Cardiac Death in Athletes)
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9 pages, 285 KiB  
Review
Sports Activity and Arrhythmic Risk in Cardiomyopathies and Channelopathies: A Critical Review of European Guidelines on Sports Cardiology in Patients with Cardiovascular Diseases
by Giovanni Volpato, Umberto Falanga, Laura Cipolletta, Manuel Antonio Conti, Gino Grifoni, Giuseppe Ciliberti, Alessia Urbinati, Alessandro Barbarossa, Giulia Stronati, Marco Fogante, Marco Bergonti, Valentina Catto, Federico Guerra, Andrea Giovagnoni, Antonio Dello Russo, Michela Casella and Paolo Compagnucci
Medicina 2021, 57(4), 308; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57040308 - 25 Mar 2021
Cited by 9 | Viewed by 2618
Abstract
The prediction and prevention of sudden cardiac death is the philosopher’s stone of clinical cardiac electrophysiology. Sports can act as triggers of fatal arrhythmias and therefore it is essential to promptly frame the athlete at risk and to carefully evaluate the suitability for [...] Read more.
The prediction and prevention of sudden cardiac death is the philosopher’s stone of clinical cardiac electrophysiology. Sports can act as triggers of fatal arrhythmias and therefore it is essential to promptly frame the athlete at risk and to carefully evaluate the suitability for both competitive and recreational sports activity. A history of syncope or palpitations, the presence of premature ventricular complexes or more complex arrhythmias, a reduced left ventricular systolic function, or the presence of known or familiar heart disease should prompt a thorough evaluation with second level examinations. In this regard, cardiac magnetic resonance and electrophysiological study play important roles in the diagnostic work-up. The role of genetics is increasing both in cardiomyopathies and in channelopathies, and a careful evaluation must be focused on genotype positive/phenotype negative subjects. In addition to being a trigger for fatal arrhythmias in certain cardiomyopathies, sports also play a role in the progression of the disease itself, especially in the case arrhythmogenic right ventricular cardiomyopathy. In this paper, we review the latest European guidelines on sport cardiology in patients with cardiovascular diseases, focusing on arrhythmic risk stratification and the management of cardiomyopathies and channelopathies. Full article
(This article belongs to the Special Issue Sudden Cardiac Death in Athletes)
14 pages, 909 KiB  
Review
Myocardial Inflammation, Sports Practice, and Sudden Cardiac Death: 2021 Update
by Paolo Compagnucci, Giovanni Volpato, Umberto Falanga, Laura Cipolletta, Manuel Antonio Conti, Gino Grifoni, Giuseppe Ciliberti, Giulia Stronati, Marco Fogante, Marco Bergonti, Elena Sommariva, Federico Guerra, Andrea Giovagnoni, Antonio Dello Russo and Michela Casella
Medicina 2021, 57(3), 277; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57030277 - 17 Mar 2021
Cited by 13 | Viewed by 3084
Abstract
Myocardial inflammation is an important cause of cardiovascular morbidity and sudden cardiac death in athletes. The relationship between sports practice and myocardial inflammation is complex, and recent data from studies concerning cardiac magnetic resonance imaging and endomyocardial biopsy have substantially added to our [...] Read more.
Myocardial inflammation is an important cause of cardiovascular morbidity and sudden cardiac death in athletes. The relationship between sports practice and myocardial inflammation is complex, and recent data from studies concerning cardiac magnetic resonance imaging and endomyocardial biopsy have substantially added to our understanding of the challenges encountered in the comprehensive care of athletes with myocarditis or inflammatory cardiomyopathy (ICM). In this review, we provide an overview of the current knowledge on the epidemiology, pathophysiology, diagnosis, and treatment of myocarditis, ICM, and myopericarditis/perimyocarditis in athletes, with a special emphasis on arrhythmias, patient-tailored therapies, and sports eligibility issues. Full article
(This article belongs to the Special Issue Sudden Cardiac Death in Athletes)
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10 pages, 291 KiB  
Review
Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes
by Nicola Tarantino, Domenico G. Della Rocca, Nicole S. De Leon De La Cruz, Eric D. Manheimer, Michele Magnocavallo, Carlo Lavalle, Carola Gianni, Sanghamitra Mohanty, Chintan Trivedi, Amin Al-Ahmad, Rodney P. Horton, Mohamed Bassiouny, J. David Burkhardt, G. Joseph Gallinghouse, Giovanni B. Forleo, Luigi Di Biase and Andrea Natale
Medicina 2021, 57(3), 205; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57030205 - 26 Feb 2021
Cited by 5 | Viewed by 1735
Abstract
A recent surveillance analysis indicates that cardiac arrest/death occurs in ≈1:50,000 professional or semi-professional athletes, and the most common cause is attributable to life-threatening ventricular arrhythmias (VAs). It is critically important to diagnose any inherited/acquired cardiac disease, including coronary artery disease, since it [...] Read more.
A recent surveillance analysis indicates that cardiac arrest/death occurs in ≈1:50,000 professional or semi-professional athletes, and the most common cause is attributable to life-threatening ventricular arrhythmias (VAs). It is critically important to diagnose any inherited/acquired cardiac disease, including coronary artery disease, since it frequently represents the arrhythmogenic substrate in a substantial part of the athletes presenting with major VAs. New insights indicate that athletes develop a specific electro-anatomical remodeling, with peculiar anatomic distribution and VAs patterns. However, because of the scarcity of clinical data concerning the natural history of VAs in sports performers, there are no dedicated recommendations for VA ablation. The treatment remains at the mercy of several individual factors, including the type of VA, the athlete’s age, and the operator’s expertise. With the present review, we aimed to illustrate the prevalence, electrocardiographic (ECG) features, and imaging correlations of the most common VAs in athletes, focusing on etiology, outcomes, and sports eligibility after catheter ablation. Full article
(This article belongs to the Special Issue Sudden Cardiac Death in Athletes)
7 pages, 1007 KiB  
Review
Diagnostic Workflow in Competitive Athletes with Ventricular Arrhythmias and Suspected Concealed Cardiomyopathies
by Maria Lucia Narducci, Michela Cammarano, Valeria Novelli, Antonio Bisignani, Chiara Pavone, Francesco Perna, Gianluigi Bencardino, Gaetano Pinnacchio, Massimiliano Bianco, Paolo Zeppilli, Vincenzo Palmieri and Gemma Pelargonio
Medicina 2021, 57(2), 182; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57020182 - 20 Feb 2021
Viewed by 1368
Abstract
The diagnosis of structural heart disease in athletes with ventricular arrhythmias (VAs) and an apparently normal heart can be very challenging. Several pieces of evidence demonstrate the importance of an extensive diagnostic work-up in apparently healthy young patients for the characterization of concealed [...] Read more.
The diagnosis of structural heart disease in athletes with ventricular arrhythmias (VAs) and an apparently normal heart can be very challenging. Several pieces of evidence demonstrate the importance of an extensive diagnostic work-up in apparently healthy young patients for the characterization of concealed cardiomyopathies. This study shows the various diagnostic levels and tools to help identify which athletes need deeper investigation in order to unmask possible underlying heart disease. Full article
(This article belongs to the Special Issue Sudden Cardiac Death in Athletes)
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15 pages, 1584 KiB  
Review
Sudden Cardiac Death in Athletes: From the Basics to the Practical Work-Up
by Adriano Nunes Kochi, Giulia Vettor, Maria Antonietta Dessanai, Francesca Pizzamiglio and Claudio Tondo
Medicina 2021, 57(2), 168; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57020168 - 14 Feb 2021
Cited by 5 | Viewed by 4931
Abstract
Sudden cardiac death in athletes is a relatively rare event, but due to the increasing number of individuals practicing high-performance sports, in absolute terms, it has become an important issue to be addressed. Since etiologies are many and the occurrence is rare, tracing [...] Read more.
Sudden cardiac death in athletes is a relatively rare event, but due to the increasing number of individuals practicing high-performance sports, in absolute terms, it has become an important issue to be addressed. Since etiologies are many and the occurrence is rare, tracing the ideal preparticipation screening program is challenging. So far, as screening tools, a comprehensive clinical evaluation and a simple 12-lead electrocardiogram (ECG) seem to be the most cost-effective strategy. Recent technological advances came to significantly help as second-line investigation tools, especially the cardiac magnetic resonance, which allows for a more detailed ventricular evaluation, cardiac tissue characterization, and eliminates the poor acoustic window problem. This article aims to review all aspects related to sudden cardiac death in athletes, beginning with definitions and epidemiology, passing through etiology and clinical characteristics, then finishing with a discussion about the best ambulatory investigational approach. Full article
(This article belongs to the Special Issue Sudden Cardiac Death in Athletes)
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10 pages, 828 KiB  
Review
Left Ventricular Non-Compaction: Review of the Current Diagnostic Challenges and Consequences in Athletes
by Giuseppe Femia, Christopher Semsarian, Samantha B. Ross, David Celermajer and Rajesh Puranik
Medicina 2020, 56(12), 697; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56120697 - 14 Dec 2020
Cited by 5 | Viewed by 1970
Abstract
Left ventricular non-compaction (LVNC) is a complex clinical condition with no diagnostic gold standard. At present, there is trepidation about the accuracy of the diagnosis, the correlation to clinical outcomes and the long-term medical management. This article reviews the current imaging criteria, the [...] Read more.
Left ventricular non-compaction (LVNC) is a complex clinical condition with no diagnostic gold standard. At present, there is trepidation about the accuracy of the diagnosis, the correlation to clinical outcomes and the long-term medical management. This article reviews the current imaging criteria, the limitations of echocardiography and cardiac magnetic resonance and the consequences of LV hypertrabeculation in athletes. Full article
(This article belongs to the Special Issue Sudden Cardiac Death in Athletes)
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