The sudden death of young competitive athletes during exercise is a shocking and widely publicized topic. These unexpected events have attracted increasing amounts of attention in the general public, particularly with the growth of online and social media. Protocols for pre-athletic participation screening have come under scrutiny to refine the detection of “silent” cardiovascular diseases that predispose young individuals to sudden cardiac death (SCD). The most common diseases include hypertrophic cardiomyopathy, coronary artery anomalies, channelopathies such as long QT syndrome, myocarditis, arrhythmogenic right ventricular cardiomyopathy, aortic dissection, coronary artery disease, dilated cardiomyopathy and Wolff-Parkinson-White syndrome. The ideal screening method for this rare but dangerous set of diseases in young athletes remains debated.
The true incidence of sudden death in young athletes is unclear. Most of the literature has relied on a retrospective evaluation of institutional reports, insurance claims, and internet searches of media reports leading to underestimation of the number of deaths. Prior studies of SCD in collegiate athletes have found a range of 1.6 to 2.4 deaths per 100,000 athlete years.1-3 In comparison, the only prospective study of U.S. high school athletes showed a similar overall incidence of 1.14 per 100,000 athlete years.4 Even this is an underestimation, since it only included events at the home high school during school hours, and deaths at night or away from school were not included. A reasonable estimate of SCD is 1:50,000 to 1:80,000 in high school athletes and 1:50,000 in college athletes, although males, African Americans, and basketball players are at higher risk.5 A prospective database of a defined population with the subsequent incidence of SCD is needed to truly determine event rates.
In an effort to limit the sudden death of otherwise healthy young individuals, the American Heart Association (AHA) recommends standardized preparticipation screening of high school athletes entailing a 12-step process evaluating symptoms, family history, and a tailored physical exam.1However, there is some evidence questioning the efficacy of this screening process. Maron and colleagues retrospectively evaluated the incidence of SCD in young athletes from 1985 to 1995.6 Despite undergoing preparticipation screening, 115 athletes died during competition, with only four of them (3%) identified as having a cardiovascular abnormality beforehand.
SOURCE: EP Lab Digest