Sudden Death in the Athlete

Arrhythmias in the athlete can range from benign and asymptomatic to highly symptomatic and life-threatening. There is risk of not diagnosing an important cardiovascular condition which may predispose to a serious or life threatening arrhythmia. At the same time there is the risk of unnecessarily restricting the athlete with a more benign condition. Sudden cardiac death in the athlete, although relatively uncommon, remains a challenge as the screening techniques for identification of individuals at risk are insensitive. Many of the underlying cardiovascular diseases responsible for sudden death with exercise can be identified. These include hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, Wolff-Parkinson-White syndrome, anomalous origin of the coronary artery, and the inherited long QT syndromes. To prevent fatalities and unnecessary restriction on athletic participation, the best available information has recently been updated with consensus recommendations and guidelines regarding eligibility. In this manuscript the cardiovascular conditions and cardiac arrhythmias that predispose to sudden cardiac death in the athlete are discussed. I N T R O D U C T I O N Sudden cardiac death in the athlete has intrigued the medical community and the public since the initial report of the unexpected death of the Greek soldier Phoedippides on completing his historic run from Marathon to Athens to deliver the message of victory over the Persians in 490 B.C. To the extent that these deaths occur in the healthiest segment of society, the unexpected death of an athlete is a tragic irony. Because sudden cardiac death in the athlete is relatively uncommon and the screening techniques for identification of individuals at risk are insensitive, the problem of sudden death remains a challenge. Many of the underlying cardiovascular diseases responsible for sudden death with exercise are now identified. These include hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, Wolff-Parkinson-White Syndrome, anomalous origin of the coronary artery, and the inherited long QT syndromes. To prevent fatalities and unnecessary restriction on athletic participation, the best available information has recently been updated with consensus recommendations and guidelines regarding eligibility. In this manuscript, we will discuss the cardiovascular conditions and cardiac arrhythmias that predispose to sudden cardiac death in the athlete. Arrhythmias in the athlete can run a range of risk from benign and asymptomatic RevIew Tufts/New England Medical Center, Boston, MA, USA HOSPITAL CHRONICLES 2007, 2(4): 151–159