Causal factors of sudden death in young athletes

Authors

  • Levi Evencio da Silva Neto Universidad Abierta Interamericana, Facultad De Medicina Y Ciencias De La Salud, Carrera De Medicina. Buenos Aires. Argentina Author
  • Ariel de Toma Universidad Abierta Interamericana, Facultad De Medicina Y Ciencias De La Salud, Carrera De Medicina. Buenos Aires. Argentina Author

DOI:

https://doi.org/10.56294/ri20266

Keywords:

Sudden, Cardiac, Death, Athletes, Exercise Therapy

Abstract

It is undeniable that physical activity provides multiple benefits, both for general health and cardiovascular health, but on rare occasions, sudden cardiac death can occur in athletes even without previous symptoms. Regarding the causes and incidences, there are different studies from various countries and regions that present different results, due to the cultural variations in each country and their practiced sports. Moreover, in some countries, like Italy for example, screenings for conditions such as hypertrophic cardiomyopathy are implemented more frequently compared to other countries. Sudden death involves a broad spectrum of associated pathologies, and in athletes or individuals under 35 years old, the most common causes are primary cardiomyopathies, cardiac channelopathies, and congenital anomalies of the coronary arteries.
Objectives: Know the main causes of sudden cardiac death in young athletes. 
Material and methods: This work is a systematic review of the literature, where different studies and articles will be analyzed to compile the most relevant and up-to-date information regarding the main causes of sudden death in young athletes. The search will be conducted through databases such as PubMed, SciELO, and the Argentine Society of Cardiology's website. 
Results: Based on the results obtained, it was observed that the most common causes of sudden death in young athletes vary depending on the region where the studies were conducted. This variation is mainly due to sociocultural factors that influence how a given society behaves and which sports are practiced. 
Conclusion: Although it is a rare event with low incidence, sudden cardiac death is a catastrophic event that, in most cases, leads to death. However, it is an event that can be prevented, and with the correct therapeutic intervention in the first few minutes, it can be successfully reversed. But to achieve this, it is necessary to understand the topic and be aware of its main causes to act correctly and efficiently.

References

1. Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022;43(40):3997–4126. doi:10.1093/eurheartj/ehac262 DOI: https://doi.org/10.1093/eurheartj/ehac262

2. Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC Guidelines for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. Eur Heart J. 2015;36:2793–867. DOI: https://doi.org/10.1093/eurheartj/ehv316

3. Solberg EE, Borjesson M, Sharma S, et al. Sudden cardiac arrest in sports - need for uniform registration: A Position Paper from the Sport Cardiology Section of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Prev Cardiol. 2016;23(6):657–67. DOI: https://doi.org/10.1177/2047487315599891

4. Iglesias D. Muerte súbita en deportistas jóvenes. Evid Actual En Pract Amb. 2011;14(3). doi:10.51987/evidencia.v14i3.6029 DOI: https://doi.org/10.51987/evidencia.v14i3.6029

5. Meyer L, Stubbs B, Fahrenbruch C, Maeda C, Harmon K, Eisenberg M, et al. Incidence, causes, and survival trends from cardiovascular-related sudden cardiac arrest in children and young adults 0 to 35 years of age: a 30-year review. Circulation. 2012;126(11):1363–72. DOI: https://doi.org/10.1161/CIRCULATIONAHA.111.076810

6. Asif IM, Harmon KG. Incidence and Etiology of Sudden Cardiac Death: New Updates for Athletic Departments. Sports Health. 2017;9(3):268–79. DOI: https://doi.org/10.1177/1941738117694153

7. Couper K, Putt O, Field R, Poole K, Bradlow W, Clarke A, et al. Incidence of sudden cardiac death in the young: a systematic review. BMJ Open. 2020;10(10):e040815. DOI: https://doi.org/10.1136/bmjopen-2020-040815

8. D'Ascenzi F, Valentini F, Pistoresi S, Frascaro F, Piu P, Cavigli L, et al. Causes of sudden cardiac death in young athletes and non-athletes: systematic review and meta-analysis. Trends Cardiovasc Med. 2022;32(5):299–308. DOI: https://doi.org/10.1016/j.tcm.2021.06.001

9. Emery MS, Kovacs RJ. Sudden Cardiac Death in Athletes. JACC Heart Fail. 2018;6(1):30–40. DOI: https://doi.org/10.1016/j.jchf.2017.07.014

10. Finocchiaro G, Papadakis M, Robertus JL, Dhutia H, Steriotis AK, Tome M, et al. Etiology of Sudden Death in Sports: Insights From a United Kingdom Regional Registry. J Am Coll Cardiol. 2016;67(18):2108–15. DOI: https://doi.org/10.1016/j.jacc.2016.02.062

11. Han J, Lalario A, Merro E, Sinagra G, Sharma S, Papadakis M, et al. Sudden Cardiac Death in Athletes: Facts and Fallacies. J Cardiovasc Dev Dis. 2023;10(2):68. DOI: https://doi.org/10.3390/jcdd10020068

12. Harmon KG, Drezner JA, Maleszewski JJ, Lopez-Anderson M, Owens D, Prutkin JM, et al. Pathogeneses of sudden cardiac death in national collegiate athletic association athletes. Circ Arrhythm Electrophysiol. 2014;7(2):198–204. DOI: https://doi.org/10.1161/CIRCEP.113.001376

13. Harmon KG. Incidence and Causes of Sudden Cardiac Death in Athletes. Clin Sports Med. 2022;41(3):369–88. DOI: https://doi.org/10.1016/j.csm.2022.02.002

14. Kochi AN, Vettor G, Dessanai MA, Pizzamiglio F, Tondo C. Sudden Cardiac Death in Athletes: From the Basics to the Practical Work-Up. Medicina (Kaunas). 2021;57(2):168. DOI: https://doi.org/10.3390/medicina57020168

15. Kumar A, Avishay DM, Jones CR, Shaikh JD, Kaur R, Aljadah M, et al. Sudden cardiac death: epidemiology, pathogenesis and management. Rev Cardiovasc Med. 2021;22(1):147–58. DOI: https://doi.org/10.31083/j.rcm.2021.01.207

16. Markwerth P, Bajanowski T, Tzimas I, Dettmeyer R. Sudden cardiac death-update. Int J Legal Med. 2021;135(2):483–95. DOI: https://doi.org/10.1007/s00414-020-02481-z

17. Sweeting J, Semsarian C. Sudden Cardiac Death in Athletes. Heart Lung Circ. 2018;27(9):1072–7. DOI: https://doi.org/10.1016/j.hlc.2018.03.026

18. Corrado D, Basso C, Rizzoli G, Schiavon M, Thiene G. Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol. 2003;42(11):1959–63. DOI: https://doi.org/10.1016/j.jacc.2003.03.002

19. Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006. Circulation. 2009;119(8):1085–92. DOI: https://doi.org/10.1161/CIRCULATIONAHA.108.804617

20. Wasfy MM, Hutter AM, Weiner RB. Sudden Cardiac Death in Athletes. Methodist Debakey Cardiovasc J. 2016;12(2):76–80. DOI: https://doi.org/10.14797/mdcj-12-2-76

21. Bayés de Luna A, Elosua R. Muerte súbita. Rev Esp Cardiol. 2012;65(11):1039–52. doi:10.1016/j.recesp.2012.03.032 DOI: https://doi.org/10.1016/j.recesp.2012.03.032

22. Maron BJ, McKenna WJ, Danielson GK, Kappenberger LJ, Kuhn HJ, Seidman CE, et al. ACC/ESC clinical expert consensus document on hypertrophic cardiomyopathy. J Am Coll Cardiol. 2003;42:1687–713. DOI: https://doi.org/10.1016/S0735-1097(03)00941-0

23. Richard P, Charron P, Carrier L, Ledeuil C, Cheav T, Pichereau C, et al. Hypertrophic cardiomyopathy: distribution of disease genes, spectrum of mutations, and implications for molecular diagnosis. Circulation. 2003;107:2227–32. DOI: https://doi.org/10.1161/01.CIR.0000066323.15244.54

24. Marcus F, McKenna W, Sherrill D, Basso C, Bauce B, Bluemke D, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: modification of task force criteria. Circulation. 2010;121:1533–41. DOI: https://doi.org/10.1161/CIRCULATIONAHA.108.840827

25. Retik E, Eidelman G, López D, Acunzo R, Aguinaga L, Cáceres M, et al. Consenso de cardiodesfibriladores. Rev Argent Cardiol. 2021;89:1–46.

26. Ackerman M, Priori S, Willems S, Berul C, Brugada R, Calkins H, et al. HRS/EHRA expert consensus on genetic testing for channelopathies and cardiomyopathies. Europace. 2011;13:1077–109. DOI: https://doi.org/10.1093/europace/eur245

27. De Noronha SV, Sharma S, Papadakis M, Desai S, Whyte G, Sheppard MN. Aetiology of sudden cardiac death in athletes in the United Kingdom: a pathological study. Heart. 2009;95:1409–14. DOI: https://doi.org/10.1136/hrt.2009.168369

28. Dubner SJ, Moss A, Riera AR, Schapachnik E. El síndrome del intervalo QT prolongado desde el punto de vista de un cardiólogo. 2004.

29. Chiang CE. Congenital and acquired long QT syndrome: current concepts and management. Cardiol Rev. 2004;12:222–34. DOI: https://doi.org/10.1097/01.crd.0000123842.42287.cf

30. El-Sherif N, Turitto G. Torsade de pointes. Curr Opin Cardiol. 2003;18:6–13. DOI: https://doi.org/10.1097/00001573-200301000-00002

31. Ackerman MJ. The long QT syndrome: ion channel diseases of the heart. Mayo Clin Proc. 1998;73:250–9. DOI: https://doi.org/10.4065/73.3.250

32. Veras FHAP, Victor EG, Saraiva LCR, Lopes MMU. [Title not provided]. Rev Bras Cardiol Invasiva. 2007;15(3):285–92. doi:10.1590/S2179-83972007000300016 DOI: https://doi.org/10.1590/S2179-83972007000300016

33. Kastellanos S, Aznaouridis K, Vlachopoulos C, Tsiamis E, Oikonomou E, Tousoulis D. Overview of coronary artery variants, aberrations and anomalies. World J Cardiol. 2018;10(10):127–40. doi:10.4330/wjc.v10.i10.127 DOI: https://doi.org/10.4330/wjc.v10.i10.127

34. Aretz HT. Myocarditis: the Dallas criteria. Hum Pathol. 1987;18(6):619–24. doi:10.1016/s0046-8177(87)80363-5 DOI: https://doi.org/10.1016/S0046-8177(87)80363-5

35. Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, et al. Current knowledge on myocarditis: a position statement of the ESC Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34(33):2636–48. doi:10.1093/eurheartj/eht210 DOI: https://doi.org/10.1093/eurheartj/eht210

36. Domínguez F, Kühl U, Pieske B, Garcia-Pavia P, Tschöpe C. Actualización sobre miocarditis y miocardiopatía inflamatoria: el resurgir de la biopsia endomiocárdica. Rev Esp Cardiol. 2016;69(2):178–87. doi:10.1016/j.recesp.2015.10.018 DOI: https://doi.org/10.1016/j.recesp.2015.10.018

37. Almendral J, Castellanos E, Ortiz M. Paroxysmal supraventricular tachycardias and preexcitation syndromes. Rev Esp Cardiol (Engl Ed). 2012;65(5):456–69. doi:10.1016/j.recesp.2011.11.026 DOI: https://doi.org/10.1016/j.rec.2011.11.020

38. Aquieri A, Rodríguez Granillo G, Vázquez Blanco M, Lerman J. Muerte súbita por conmoción cardíaca (Commotio cordis) asociada a miocardio no compactado. Medicina (B Aires). 2011;71(6):542–6. Disponible en: http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S0025-76802011000800007

39. Link MS. Commotio cordis: ventricular fibrillation from chest impact–induced abnormalities in repolarization. Circ Arrhythm Electrophysiol. 2012;5:425–32. doi:10.1161/CIRCEP.111.962712 DOI: https://doi.org/10.1161/CIRCEP.111.962712

40. 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(6):337–42. DOI: https://doi.org/10.1056/NEJM199508103330602

Downloads

Published

2025-02-13

How to Cite

1.
da Silva Neto LE, de Toma A. Causal factors of sudden death in young athletes. Rehabilitation and Sports Medicine [Internet]. 2025 Feb. 13 [cited 2026 Jan. 18];5:6. Available from: https://ri.ageditor.ar/index.php/ri/article/view/6