Sports-Related Sudden Cardiac Death (SSCD): Insights into Epidemiology, Risk Factors, and Preventive Strategies

Authors

  • M. M. AlRayes 1. Department of Physiotherapy, College of Health and Sport Sciences, University of Bahrain, Manama, Bahrain, 2. Department of Physiotherapy, Sh. Jaber Al Ahmed Al Sabah Health Center, Barbar, Bahrain
  • M. A. Husain Department of Physiotherapy, College of Health and Sport Sciences, University of Bahrain, Manama, Bahrain

DOI:

https://doi.org/10.62464/ijoprp.v3i8.45

Keywords:

Sports-Related Sudden cardiac death (SSCD), exercise, screening, risk factor, prevention.

Abstract

Sports-Related Sudden cardiac death (SSCD) is a tragic and emotionally impacting event generating considerable attention in the community and media. It is a leading cause of mortality in the athletic population. Although rare, it causes a shock as those athletes are health models for the sports spectators. The current focused review aims to highlight the latest evidence regarding this important topic and provide a baseline introduction to future related research. The literature review was done through scientific search engines (Scopus, google scholar, Science Direct, Research gate, and PubMed). The inclusion criteria covered the full access English language Sources published between 2002 till 2022. The current review describes the main issues related to the SSCD such as the definition, epidemiology, etiology, risk factors, warning signs and symptoms, role of screening, prevention and management, COVID-19 and SSCD, and future directions. This review highlights key insights into Sports-Related Sudden Cardiac Death (SSCD) and provides a foundation for future research to improve understanding and prevention.

References

Alattar, A., Ghani, S., Mahdy, N., Hussain, H., & Maffulli, N. (2014). Pre-participation musculoskeletal and cardiac screening of male athletes in the United Arab Emirates. Translational medicine @ Unisa, 9, 43–49.

American College of Sports Medicine. (2017, February 9). ACSM’s Guidelines for Exercise Testing and Prescription (American College of Sports Medicine) (10th ed.). LWW.

American College of Sports Medicine (2019.). American College of Sports Medicine Risk Stratification Chart. https://www.acsm.org/blog-detail/acsm-certified-blog/2019/11/11/acsm-risk-stratification-chart-download

Angelini, P. (2013). Preventing Sudden Cardiac Death in Athletes. Texas Heart Institute Journal, 40(2), 8.

Asif, I. M., Rao, A. L., & Drezner, J. A. (2013). Sudden cardiac death in young athletes: What is the role of screening? Current Opinion in Cardiology, 28(1), 55–62. https://doi.org/10.1097/HCO.0b013e32835b0ab9 DOI: https://doi.org/10.1097/HCO.0b013e32835b0ab9

Asplund, C. A., & O’Connor, F. G. (2016). The evidence against cardiac screening using electrocardiogram in athletes. Current sports medicine reports, 15(2), 81-85. DOI: https://doi.org/10.1249/JSR.0000000000000237

Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., ... & de Ferranti, S. D. (2019). Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation, 139(56-528). DOI: https://doi.org/10.1161/CIR.0000000000000659

Bessem, B., De Bruijn, M. C., & Nieuwland, W. (2015). The ECG of high-level junior soccer players: comparing the ESC vs. the Seattle criteria. British Journal of Sports Medicine, 49(15), 1000-1006. DOI: https://doi.org/10.1136/bjsports-2013-093245

Blom, M. T., Beesems, S. G., Homma, P. C., Zijlstra, J. A., Hulleman, M., van Hoeijen, D. A., ... & Koster, R. W. (2014). Improved survival after out-of-hospital cardiac arrest and use of automated external defibrillators. Circulation, 130(21), 1868-1875. DOI: https://doi.org/10.1161/CIRCULATIONAHA.114.010905

Brosnan, M., La Gerche, A., Kalman, J., Lo, W., Fallon, K., MacIsaac, A., & Prior, D. (2014). The Seattle Criteria increase the specificity of pre-participation ECG screening among elite athletes. British Journal of Sports Medicine, 48(15), 1144-1150. DOI: https://doi.org/10.1136/bjsports-2013-092420

Chaitman, B. R. (2007). An Electrocardiogram Should Not Be Included in Routine Pre-participation Screening of Young Athletes. Circulation, 116(22), 2610–2615. https://doi.org/10.1161/CIRCULATIONAHA.107.711465 DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.711465

Colombo, C. S. S., Papadakis, M., & Ghorayeb, N. (2019). Sudden Cardiac Arrest. In The Sports Medicine Physician (pp. 413-428). Springer, Cham. DOI: https://doi.org/10.1007/978-3-030-10433-7_30

Corrado, D., Basso, C., Pavei, A., Michieli, P., Schiavon, M., & Thiene, G. (2006). Trends in Sudden Cardiovascular Death in Young Competitive Athletes after Implementation of a Pre-participation Screening Program. Journal of American Medical Association, 296, 9. DOI: https://doi.org/10.1001/jama.296.13.1593

Corrado, D., Basso, C., Rizzoli, G., Schiavon, M., & Thiene, G. (2003). Does sports activity enhance the risk of sudden death in adolescents and young adults? Journal of the American College of Cardiology, 42(11), 1959-1963. DOI: https://doi.org/10.1016/j.jacc.2003.03.002

D’Silva, A., & Papadakis, M. (2015). Sudden Cardiac Death in Athletes. European cardiology review, 10(1), 6. DOI: https://doi.org/10.15420/ecr.2015.10.01.48

Dhutia, H., & MacLachlan, H. (2018). Cardiac Screening of Young Athletes: A Practical Approach to Sudden Cardiac Death Prevention. Current Treatment Options in Cardiovascular Medicine, 20(10), 85. https://doi.org/10.1007/s11936-018-0681-4 DOI: https://doi.org/10.1007/s11936-018-0681-4

Drezner, J. A. (2009). Preparing for sudden cardiac arrest—the essential role of automated external defibrillators in athletic medicine: a critical review. British journal of sports medicine, 43(9), 702-707. DOI: https://doi.org/10.1136/bjsm.2008.054890

Drezner, J. A., Courson, R. W., Roberts, W. O., Mosesso Jr, V. N., Link, M. S., & Maron, B. J. (2007). Inter-association task force recommendations on emergency preparedness and management of sudden cardiac arrest in high school and college athletic programs: a consensus statement. Heart Rhythm, 4(4), 549-565. DOI: https://doi.org/10.1016/j.hrthm.2007.02.019

Dunn, T. P., Pickham, D., Aggarwal, S., Saini, D., Kumar, N., Wheeler, M. T. ... & Froelicher, V. F. (2015). Limitations of current AHA guidelines and proposal of new guidelines for the pre-participation examination of athletes. Clinical Journal of Sports Medicine, 25(6), 472-477. DOI: https://doi.org/10.1097/JSM.0000000000000203

Egger, F., Scharhag, J., Kästner, A., Dvořák, J., Bohm, P., & Meyer, T. (2022). FIFA Sudden Death Registry (FIFA-SDR): a prospective, observational study of sudden death in worldwide football from 2014 to 2018. British journal of sports medicine, 56(2), 80-87. DOI: https://doi.org/10.1136/bjsports-2020-102368

Emery, M. S., & Kovacs, R. J. (2018). Sudden Cardiac Death in Athletes. JACC: Heart Failure, 6(1), 30–40. https://doi.org/10.1016/j.jchf.2017.07.014 DOI: https://doi.org/10.1016/j.jchf.2017.07.014

Fudge, J., Harmon, K. G., Owens, D. S., Prutkin, J. M., Salerno, J. C., Asif, I. M., ... & Drezner, J. A. (2014). Cardiovascular screening in adolescents and young adults: a prospective study comparing the Pre-participation Physical Evaluation Monograph 4th Edition and ECG. British Journal of Sports Medicine, 48(15), 1172-1178. DOI: https://doi.org/10.1136/bjsports-2014-093840

Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Borden, W. B. ... & Franco, S. (2013). Executive summary: heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation, 127(1), 143-152. DOI: https://doi.org/10.1161/CIR.0b013e318282ab8f

Gonzalez, M. M., Marques, F. R. B., Vianna, C. B., Eid, C. A., Feitosa-Filho, G. S., & Timerman, S. (2009). Ventricular fibrillation during sport activity successfully treated. Arquivos Brasileiros de Cardiologia, 93(2), e14-e17. DOI: https://doi.org/10.1590/S0066-782X2009000800022

Halkin, A., Steinvil, A., Rosso, R., Adler, A., Rozovski, U., & Viskin, S. (2012). Preventing Sudden Death of Athletes with Electrocardiographic Screening. Journal of the American College of Cardiology, 60(22), 2271–2276. https://doi.org/10.1016/j.jacc.2012.09.003 DOI: https://doi.org/10.1016/j.jacc.2012.09.003

Hamad, A. (2020, Feb). Report of the National Committee Investigating the Causes of Sudden Cardiac Deaths in the Walkways and Gyms in Bahrain. Paper presented at the UK-BH Sports, Health and Exercise Science Symposium, Manama. Bahrain.

Harmon, K. G., Asif, I. M., Klossner, D., & Drezner, J. A. (2011). Incidence of sudden cardiac death in National Collegiate Athletic Association athletes. Circulation, 123(15), 1594-1600. DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.004622

Harmon, K. G., Drezner, J. A., Wilson, M. G., & Sharma, S. (2014). Incidence of sudden cardiac death in athletes: A state-of-the-art review. British Journal of Sports Medicine, 48(15), 1185–1192. https://doi.org/10.1136/bjsports-2014-093872 DOI: https://doi.org/10.1136/bjsports-2014-093872

Higgins, J. P., & Cadigan, J. B. (2016). Electrocardiogram screening in athletes: A good return on investment. The American journal of medicine, 129(2), e3-e5. DOI: https://doi.org/10.1016/j.amjmed.2015.07.021

Isbister, J., & Semsarian, C. (2019). Sudden cardiac death: an update. Internal medicine journal, 49(7), 826-833. DOI: https://doi.org/10.1111/imj.14359

Karam, N., Narayanan, K., Bougouin, W., Benameur, N., Beganton, F., Jost, D. ... & Marijon, E. (2017). Major regional differences in Automated External Defibrillator placement and Basic Life Support training in France: Further needs for coordinated implementation. Resuscitation, 118, 49-54. DOI: https://doi.org/10.1016/j.resuscitation.2017.07.002

Khan, Z., Na, J. S., & Jerome, S. (2021). Review of COVID-19 Myocarditis in Competitive Athletes: Legitimate Concern or Fake News? Frontiers in cardiovascular medicine, 689. DOI: https://doi.org/10.3389/fcvm.2021.684780

Link, M. S., & Estes, N. A., 3rd (2012). Sudden cardiac death in the athlete: bridging the gaps between evidence, policy, and practice. Circulation, 125(20), 2511–2516. https://doi.org/10.1161/CIRCULATIONAHA.111.023861 DOI: https://doi.org/10.1161/CIRCULATIONAHA.111.023861

Link, M. S., Myerburg, R. J., & Estes, N. M. (2015). Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 12: emergency action plans, resuscitation, cardiopulmonary resuscitation, and automated external defibrillators: a scientific statement from the American Heart Association and American College of Cardiology. Journal of the American College of Cardiology, 66(21), 2434-2438. DOI: https://doi.org/10.1016/j.jacc.2015.09.044

Lippi, G., Favaloro, E., & Sanchis-Gomar, F. (2018). Sudden Cardiac and Non-cardiac Death in Sports: Epidemiology, Causes, Pathogenesis, and Prevention. Seminars in Thrombosis and Hemostasis, 44(08), 780–786. https://doi.org/10.1055/s-0038-1661334 DOI: https://doi.org/10.1055/s-0038-1661334

Löllgen, H., Leyk, D., & Hansel, J. (2010). The Pre-Participation Examination for Leisure Time Physical Activity. Deutsches Aerzteblatt Online, 107(42), 742–9. https://doi.org/10.3238/arztebl.2010.0742 DOI: https://doi.org/10.3238/arztebl.2010.0742

Maffey, L., & Emery, C. (2006). Physiotherapist delivered preparticipation examination: rationale and evidence. North American journal of sports physical therapy, 1(4), 176.

Marijon, E., Tafflet, M., Celermajer, D. S., Dumas, F., Perier, M. C., Mustafic, H. ... & Le Heuzey, J. Y. (2011). Sports-related sudden death in the general population. Circulation, 124(6), 672-681. DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.008979

Maron, B. J. (2002). Hypertrophic cardiomyopathy: a systematic review. Journal of American Medical Association, 287(10), 1308-1320. DOI: https://doi.org/10.1001/jama.287.10.1308

Maron, B. J. (2010). Risk Stratification and Role of Implantable Defibrillators for Prevention of Sudden Death in Patients with Hypertrophic Cardiomyopathy. Circulation Journal, 74(11), 2271–2282. https://doi.org/10.1253/circj.CJ-10-0921 DOI: https://doi.org/10.1253/circj.CJ-10-0921

Maron, B. J., & Zipes, D. P. (2005). 36th Bethesda Conference: eligibility recommendations for competitive athletes with cardiovascular abnormalities. Journal American College Cardiology, 45(8), 1318-1321. DOI: https://doi.org/10.1016/j.jacc.2005.02.006

Maron, B. J., Friedman, R. A., Kligfield, P., Levine, B. D., Viskin, S., Chaitman, B. R. ... & Soliman, E. Z. (2014). Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12–25 years of age) a scientific statement from the American Heart Association and the American College of Cardiology. Circulation, 130(15), 1303-1334. DOI: https://doi.org/10.1161/CIR.0000000000000025

Maron, B. J., Haas, T. S., Ahluwalia, A., Murphy, C. J., & Garberich, R. F. (2016). Demographics and epidemiology of sudden deaths in young competitive athletes: from the United States National Registry. The American journal of medicine, 129(11), 1170-1177. DOI: https://doi.org/10.1016/j.amjmed.2016.02.031

Mont, L., Pelliccia, A., Sharma, S., Biffi, A., Borjesson, M., Terradellas, J. B. ... & Lampert, R. (2017). Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: Position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Ep Europace, 19(1), 139-163.

Myerburg, R. J., & Vetter, V. L. (2007). Electrocardiograms should be included in pre-participation screening of athletes. Circulation, 116(22). DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.733519

Palmieri, V., Gervasi, S., Bianco, M., Cogliani, R., Poscolieri, B., Cuccaro, F. ... & Zeppilli, P. (2018). Anomalous origin of coronary arteries from the “wrong” sinus in athletes: diagnosis and management strategies. International journal of cardiology, 252, 13-20. DOI: https://doi.org/10.1016/j.ijcard.2017.10.117

Papadakis, M., Sharma, S., Cox, S., Sheppard, M. N., Panoulas, V. F., & Behr, E. R. (2009). The magnitude of sudden cardiac death in the young: a death certificate-based review in England and Wales. Europace, 11(10), 1353-1358. DOI: https://doi.org/10.1093/europace/eup229

Bauer, P., Kraushaar, L., Most, A., Hölscher, S., Tajmiri-Gondai, S., Dörr, O., Troidl, C., Bauer, T., Nef, H., Hamm, C. W., & Keller, T. (2019). Impact of Vascular Function on Maximum Power Output in Elite Handball Athletes. Research quarterly for exercise and sport, 90(4), 600–608. https://doi.org/10.1080/02701367.2019.1639602 DOI: https://doi.org/10.1080/02701367.2019.1639602

Pelliccia, A., Sharma, S., Gati, S., Bäck, M., Börjesson, M., Caselli, S., Collet, J. P., Corrado, D., Drezner, J. A., Halle, M., Hansen, D., Heidbuchel, H., Myers, J., Niebauer, J., Papadakis, M., Piepoli, M. F., Prescott, E., Roos-Hesselink, J. W., Graham Stuart, A., Taylor, R. S., … ESC Scientific Document Group (2021). 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. European heart journal, 42(1), 17–96. https://doi.org/10.1093/eurheartj/ehaa605 DOI: https://doi.org/10.1016/j.rec.2021.05.003

Pescatello, L. S., Riebe, D., & Thompson, P. D. (Eds.). (2014). ACSM's guidelines for exercise testing and prescription. Lippincott Williams & Wilkins.

Pickham, D., Zarafshar, S., Sani, D., Kumar, N., & Froelicher, V. (2014). Comparison of three ECG criteria for athlete pre-participation screening. Journal of electrocardiology, 47(6), 769-774. DOI: https://doi.org/10.1016/j.jelectrocard.2014.07.019

Rao, A. L., Standaert, C. J., Drezner, J. A., & Herring, S. A. (2010). Expert opinion and controversies in musculoskeletal and sports medicine: preventing sudden cardiac death in young athletes. Archives of physical medicine and rehabilitation, 91(6), 958-962. DOI: https://doi.org/10.1016/j.apmr.2010.02.006

Riebe, D., Franklin, B. A., Thompson, P. D., Garber, C. E., Whitfield, G. P., Magal, M., & Pescatello, L. S. (2015). Updating ACSM's recommendations for exercise preparticipation health screening. https://doi.org/10.7916/D8M908BH DOI: https://doi.org/10.1249/MSS.0000000000000664

Sanders, B., Blackburn, T. A., & Boucher, B. (2013). Preparticipation screening–the sports physical therapy perspective. International journal of sports physical therapy, 8(2), 180.

Schmehil, C., Malhotra, D., & Patel, D. R. (2017). Cardiac screening to prevent sudden death in young athletes. Translational Pediatrics, 6(3), 199–206. https://doi.org/10.21037/tp.2017.05.04 DOI: https://doi.org/10.21037/tp.2017.05.04

Semsarian, C., Sweeting, J., & Ackerman, M. J. (2015). Sudden cardiac death in athletes. British Journal of Sports Medicine, 49(15), 1017–1023. https://doi.org/10.1136/bjsports-2015-h1218rep DOI: https://doi.org/10.1136/bjsports-2015-h1218rep

Seto, C. K., & Pendleton, M. E. (2009). Pre-participation cardiovascular screening in young athletes: current guidelines and dilemmas. Current sports medicine reports, 8(2), 59-64. DOI: https://doi.org/10.1249/JSR.0b013e31819ccdaf

Steinvil, A., Chundadze, T., Zeltser, D., Rogowski, O., Halkin, A., Galily, Y. ... & Viskin, S. (2011). Mandatory electrocardiographic screening of athletes to reduce their risk for sudden death: proven fact or wishful thinking? Journal of the American College of Cardiology, 57(11), 1291-1296. DOI: https://doi.org/10.1016/j.jacc.2010.10.037

Tan, H. L., Hofman, N., Van Langen, I. M., van der Wal, A. C., & Wilde, A. A. (2005). Sudden unexplained death: heritability and diagnostic yield of cardiological and genetic examination in surviving relatives. Circulation, 112(2), 207-213. DOI: https://doi.org/10.1161/CIRCULATIONAHA.104.522581

Toresdahl, B. G., Rao, A. L., Harmon, K. G., & Drezner, J. A. (2014). Incidence of sudden cardiac arrest in high school student athletes on school campus. Heart Rhythm, 11(7), 1190-1194. DOI: https://doi.org/10.1016/j.hrthm.2014.04.017

Vancini, Nikolaidis, Lira, Vancini-Campanharo, Viana, dos Santos Andrade, Rosemann, & Knechtle. (2019). Prevention of Sudden Death Related to Sport: The Science of Basic Life Support—from Theory to Practice. Journal of Clinical Medicine, 8(4), 556. https://doi.org/10.3390/jcm8040556 DOI: https://doi.org/10.3390/jcm8040556

Vetter, V. L., Dugan, N., Guo, R., Mercer-Rosa, L., Gleason, M., Cohen, M. ... & Iyer, R. (2011). A pilot study of the feasibility of heart screening for sudden cardiac arrest in healthy children. American heart journal, 161(5), 1000-1006. DOI: https://doi.org/10.1016/j.ahj.2011.01.022

Warburton, D., Jamnik, V., Bredin, S., Shephard, R., & Gledhill, N. (2021). The 2021 Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and electronic Physical Activity Readiness Medical Examination (ePARmed-X+): 2021 PAR-Q+. The Health &Amp; Fitness Journal of Canada, 14(1), 83–87. https://doi.org/10.14288/hfjc.v14i1.351

Weiner, R. B., Hutter, A. M., Wang, F., Kim, J. H., Wood, M. J., Wang, T. J. ... & Baggish, A. L. (2011). Performance of the 2010 European Society of Cardiology criteria for ECG interpretation in athletes. Heart, 97(19), 1573-1577. DOI: https://doi.org/10.1136/hrt.2011.227330

Wellens, H. J., Schwartz, P. J., Lindemans, F. W., Buxton, A. E., Goldberger, J. J., Hohnloser, S. H., ... & Myerburg, R. J. (2014). Risk stratification for sudden cardiac death: current status and challenges for the future. European heart journal, 35(25), 1642-1651. DOI: https://doi.org/10.1093/eurheartj/ehu176

Wheeler, M. T. (2010). Cost-Effectiveness of Pre-participation Screening for Prevention of Sudden Cardiac Death in Young Athletes. Annals of Internal Medicine, 152(5), 276. https://doi.org/10.7326/0003-4819-152-5-201003020-00005 DOI: https://doi.org/10.7326/0003-4819-152-5-201003020-00005

White, M. J., Duquette, D., Bach, J., Rafferty, A. P., Fussman, C., Sharangpani, R., & Russell, M. W. (2015, December). Family history of sudden cardiac death of the young: prevalence and associated factors in healthcare. Multidisciplinary Digital Publishing Institute, 3(4), 1086-1096. DOI: https://doi.org/10.3390/healthcare3041086

Williams, E. A., Pelto, H. F., Toresdahl, B. G., Prutkin, J. M., Owens, D. S., Salerno, J. C., Harmon, K. G., & Drezner, J. A. (2019). Performance of the American Heart Association (AHA) 14‐Point Evaluation Versus Electrocardiography for the Cardiovascular Screening of High School Athletes: A Prospective Study. Journal of the American Heart Association, 8(14). https://doi.org/10.1161/JAHA.119.012235 DOI: https://doi.org/10.1161/JAHA.119.012235

Wilson, M. G., Drezner, J. A., Sharma, S., & International Olympic Committee (Eds.). (2017). IOC manual of sports cardiology. Wiley, Blackwell. DOI: https://doi.org/10.1002/9781119046899

Downloads

Published

2024-09-30

How to Cite

AlRayes, M. M., & Husain, M. A. (2024). Sports-Related Sudden Cardiac Death (SSCD): Insights into Epidemiology, Risk Factors, and Preventive Strategies. International Journal of Physical Therapy Research &Amp; Practice, 3(8), 340–352. https://doi.org/10.62464/ijoprp.v3i8.45

Issue

Section

Original Research