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 1996-2008, 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 age of death was 28 ± 12 years old (range 7-59 years old); 75% athletes were aged < 35 years of age. Most deaths (81%) occurred during or immediately after exercise. Antecedent symptoms of cardiac disease were reported in 18% and 17% had a family history or premature cardiovascular disease or SCD. Twenty one per cent of 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 old.
Conclusions: Sudden cardiac death 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, therefore clinical screening with health questionnaires will fail to identify most athletes with potentially sinister cardiac disorders.
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