Objective: To characterise the demographics and aetiology of sudden cardiac death (SCD) in athletes referred to a tertiary cardiac pathology centre in the UK.
Design: Retrospective non-case controlled analysis.
Setting: Cardiac pathology centre at the National Heart and Lung Institute and Royal Brompton Hospital.
Subjects: Between 1996 and 2008, the hearts of 118 athletes were referred for pathological assessment to ascertain the precise aetiology of SCD.
Results: The majority of athletes (n = 113; 96%) were male and most (107; 91%) were amateurs participating predominantly in football, rugby and running. The mean (SD) age of death was 28 (12) years (range 7–59); 75% athletes were aged ⩽35 years. Most deaths (81%) occurred during or immediately after exercise. Antecedent symptoms of cardiac disease were reported in 21 (18%) subjects, and 20 (17%) had a family history of premature cardiovascular disease and/or SCD. 25 (21%) athletes had relevant past medical history which included a known history of cardiac disease. Cardiomyopathy was the commonest cause of death and accounted for 62% of all the SCDs. A significantly high proportion of athletes (23%) exhibited a morphologically normal heart. Atherosclerotic coronary disease accounted for only 3% of cases and was confined to athletes aged >35 years.
Conclusions: SCD in sport is largely due to clinically silent cardiomyopathies or primary electrical disorders (morphologically normal heart). Antecedent symptoms and family history are absent in over 80% of cases, and therefore clinical screening with health questionnaires will fail to identify most athletes with potentially sinister cardiac disorders.
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Funding The study was part funded by the charitable organisation Cardiac Risk in the Young. SN is funded by a research fellow grant by CRY. MP is funded by a junior research fellowship grant by CRY.
Competing interests SS is consultant cardiologist and trustee to the charitable organisation Cardiac Risk in the Young (CRY) and has received research grants from CRY. GW is CRY trustee and has received research grants from CRY. MS has received a research grant from CRY. SN and MP are funded by research fellowship grants from CRY.
Ethics approval Brompton, Harefield and National Heart and Lung Institute: Ref 07/Q040.
Authorship and contributorship: SN, conception and design, literature search, analysis and interpretation of data and drafting the article; SS, SD, MP, GW, MNS, analysis and interpretation of data, drafting the article or revising it critically for important intellectual content; MNS, additionally, performed post mortems. All the authors approved the final version to be published.