Sudden Cardiac Death in Athletes

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

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