Skip to main content
SpringerLink
Log in

Incidence and Causes of Sudden Cardiac Death in Recreational Athletes

  • Chapter
  • First Online:
Textbook of Sports and Exercise Cardiology

  • 1260 Accesses

Abstract

Sudden cardiac death (SCD) during sports activities accounts for a small but significant proportion of all SCD, with recent studies consistently reporting around 5% of overall SCD occurring during sporting activity. The emphasis on young competitive athletes as opposed to recreational sports participants is discordant with the relative magnitudes of the respective problems, which was recently highlighted by several recent population-based studies. There is a crucial need to focus attention on this large at-risk population of subjects. Although coronary artery disease represents the vast majority of underlying mechanisms in recreational middle age cases, cardiomyopathies and inherited electrical disorders remain significant among the youngest. Strategies to reduce SCD burden related to sports should incorporate targeted screening, public education and consideration of warming symptoms, improving rates of bystander CPR and early AED use.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med. 2000;343(19):1355–61.

    CAS  PubMed  Google Scholar 

  2. Conraads VM, Beckers P, Vaes J, Martin M, Van Hoof V, De Maeyer C, et al. Combined endurance/resistance training reduces NT-proBNP levels in patients with chronic heart failure. Eur Heart J. 2004;25(20):1797–805.

    CAS  PubMed  Google Scholar 

  3. Lee DC, Pate RR, Lavie CJ, Sui X, Church TS, Blair SN. Leisure-time running reduces all-cause and cardiovascular mortality risk. J Am Coll Cardiol. 2014;64(5):472–81.

    PubMed  PubMed Central  Google Scholar 

  4. Maron BJ. The paradox of exercise. N Engl J Med. 2000;343(19):1409–11.

    CAS  PubMed  Google Scholar 

  5. Sharma S, Merghani A, Mont L. Exercise and the heart: the good, the bad, and the ugly. Eur Heart J. 2015;36(23):1445–53.

    PubMed  Google Scholar 

  6. Siscovick DS, Weiss NS, Fletcher RH, Lasky T. The incidence of primary cardiac arrest during vigorous exercise. N Engl J Med. 1984;311(14):874–7.

    CAS  PubMed  Google Scholar 

  7. Whang W, Manson JE, Hu FB, Chae CU, Rexrode KM, Willett WC, et al. Physical exertion, exercise, and sudden cardiac death in women. JAMA. 2006;295(12):1399–403.

    CAS  PubMed  Google Scholar 

  8. Dahabreh IJ, Paulus JK. Association of episodic physical and sexual activity with triggering of acute cardiac events: systematic review and meta-analysis. JAMA. 2011;305(12):1225–33.

    PubMed  PubMed Central  Google Scholar 

  9. Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296(13):1593–601.

    CAS  PubMed  Google Scholar 

  10. Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006. Circulation. 2009;119(8):1085–92.

    PubMed  Google Scholar 

  11. Maron BJ, Shirani J, Poliac LC, Mathenge R, Roberts WC, Mueller FO. Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA. 1996;276(3):199–204.

    CAS  PubMed  Google Scholar 

  12. Jouven X, Bougouin W, Karam N, Marijon E. Epidemiology of sudden cardiac death: data from the Paris sudden death expertise center registry. Rev Prat. 2015;65(7):916–8.

    PubMed  Google Scholar 

  13. Waldmann V, Bougouin W, Karam N, Albuisson J, Cariou A, Jouven X, et al. Sudden cardiac death: a better understanting for a better prevention. Ann Cardiol Angeiol (Paris). 2017;66(4):230–8.

    CAS  Google Scholar 

  14. Arena R, Guazzi M, Lianov L, Whitsel L, Berra K, Lavie CJ, et al. Healthy lifestyle interventions to combat noncommunicable disease-a novel nonhierarchical connectivity model for key stakeholders: a policy statement from the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine. Eur Heart J. 2015;36(31):2097–109.

    PubMed  Google Scholar 

  15. Morseth B, Graff-Iversen S, Jacobsen BK, Jorgensen L, Nyrnes A, Thelle DS, et al. Physical activity, resting heart rate, and atrial fibrillation: the Tromso study. Eur Heart J. 2016;37(29):2307–13.

    PubMed  PubMed Central  Google Scholar 

  16. Tanasescu M, Leitzmann MF, Rimm EB, Willett WC, Stampfer MJ, Hu FB. Exercise type and intensity in relation to coronary heart disease in men. JAMA. 2002;288(16):1994–2000.

    PubMed  Google Scholar 

  17. Morris JN, Everitt MG, Pollard R, Chave SP, Semmence AM. Vigorous exercise in leisure-time: protection against coronary heart disease. Lancet. 1980;2(8206):1207–10.

    CAS  PubMed  Google Scholar 

  18. Marijon E, Bougouin W, Jouven X. Sports-related sudden death: lessons from the French registry. Rev Prat. 2015;65(7):919–23.

    PubMed  Google Scholar 

  19. Tabib A, Miras A, Taniere P, Loire R. Undetected cardiac lesions cause unexpected sudden cardiac death during occasional sport activity. A report of 80 cases. Eur Heart J. 1999;20(12):900–3.

    CAS  PubMed  Google Scholar 

  20. Chiuve SE, Fung TT, Rexrode KM, Spiegelman D, Manson JE, Stampfer MJ, et al. Adherence to a low-risk, healthy lifestyle and risk of sudden cardiac death among women. JAMA. 2011;306(1):62–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Deo R, Albert CM. Epidemiology and genetics of sudden cardiac death. Circulation. 2012;125(4):620–37.

    PubMed  PubMed Central  Google Scholar 

  22. Deo R, Vittinghoff E, Lin F, Tseng ZH, Hulley SB, Shlipak MG. Risk factor and prediction modeling for sudden cardiac death in women with coronary artery disease. Arch Intern Med. 2011;171(19):1703–9.

    PubMed  PubMed Central  Google Scholar 

  23. Lemaitre RN, Siscovick DS, Raghunathan TE, Weinmann S, Arbogast P, Lin DY. Leisure-time physical activity and the risk of primary cardiac arrest. Arch Intern Med. 1999;159(7):686–90.

    CAS  PubMed  Google Scholar 

  24. Wannamethee G, Shaper AG, Macfarlane PW, Walker M. Risk factors for sudden cardiac death in middle-aged British men. Circulation. 1995;91(6):1749–56.

    CAS  PubMed  Google Scholar 

  25. Wen CP, Wai JP, Tsai MK, Yang YC, Cheng TY, Lee MC, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. 2011;378(9798):1244–53.

    PubMed  Google Scholar 

  26. O'Keefe JH, Lavie CJ. Run for your life ... at a comfortable speed and not too far. Heart. 2013;99(8):516–9.

    PubMed  Google Scholar 

  27. Schnohr P, O’Keefe JH, Marott JL, Lange P, Jensen GB. Dose of jogging and long-term mortality: the Copenhagen City Heart Study. J Am Coll Cardiol. 2015;65(5):411–9.

    PubMed  Google Scholar 

  28. Marijon E, Tafflet M, Antero-Jacquemin J, El Helou N, Berthelot G, Celermajer DS, et al. Mortality of French participants in the tour de France (1947–2012). Eur Heart J. 2013;34(40):3145–50.

    PubMed  Google Scholar 

  29. Zaidi A, Sharma S. Reduced mortality in former tour de France participants: the benefits from intensive exercise or a select genetic tour de force? Eur Heart J. 2013;34(40):3106–8.

    PubMed  Google Scholar 

  30. Corrado D, Basso C, Rizzoli G, Schiavon M, Thiene G. Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol. 2003;42(11):1959–63.

    PubMed  Google Scholar 

  31. Marijon E, Tafflet M, Celermajer DS, Dumas F, Perier MC, Mustafic H, et al. Sports-related sudden death in the general population. Circulation. 2011;124(6):672–81.

    PubMed  Google Scholar 

  32. Pelliccia A, Di Paolo FM, Corrado D, Buccolieri C, Quattrini FM, Pisicchio C, et al. Evidence for efficacy of the Italian national pre-participation screening programme for identification of hypertrophic cardiomyopathy in competitive athletes. Eur Heart J. 2006;27(18):2196–200.

    PubMed  Google Scholar 

  33. Dvorak J. A lion never dies: pro memoria of Marc-Vivien foe. Br J Sports Med. 2009;43(9):628.

    PubMed  Google Scholar 

  34. Myngheer D. Cycling mourns second Belgian death. 2016. http://www.bbc.com/sport/cycling/35914893.

  35. Gerardin B, Collet JP, Mustafic H, Bellemain-Appaix A, Benamer H, Monsegu J, et al. Registry on acute cardiovascular events during endurance running races: the prospective RACE Paris registry. Eur Heart J. 2016;37(32):2531–41.

    PubMed  Google Scholar 

  36. Kim JH, Malhotra R, Chiampas G, d'Hemecourt P, Troyanos C, Cianca J, et al. Cardiac arrest during long-distance running races. N Engl J Med. 2012;366(2):130–40.

    CAS  PubMed  Google Scholar 

  37. Harmon KG, Asif IM, Klossner D, Drezner JA. Incidence of sudden cardiac death in National Collegiate Athletic Association athletes. Circulation. 2011;123(15):1594–600.

    PubMed  Google Scholar 

  38. Berdowski J, de Beus MF, Blom M, Bardai A, Bots ML, Doevendans PA, et al. Exercise-related out-of-hospital cardiac arrest in the general population: incidence and prognosis. Eur Heart J. 2013;34(47):3616–23.

    PubMed  Google Scholar 

  39. Marijon E, Uy-Evanado A, Reinier K, Teodorescu C, Narayanan K, Jouven X, et al. Sudden cardiac arrest during sports activity in middle age. Circulation. 2015;131(16):1384–91.

    PubMed  PubMed Central  Google Scholar 

  40. Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation. 2010;81(11):1479–87.

    PubMed  Google Scholar 

  41. Hasselqvist-Ax I, Riva G, Herlitz J, Rosenqvist M, Hollenberg J, Nordberg P, et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. N Engl J Med. 2015;372(24):2307–15.

    CAS  PubMed  Google Scholar 

  42. Kudenchuk PJ, Brown SP, Daya M, Rea T, Nichol G, Morrison LJ, et al. Amiodarone, Lidocaine, or placebo in out-of-hospital cardiac arrest. N Engl J Med. 2016;374(18):1711–22.

    CAS  PubMed  Google Scholar 

  43. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29–322.

    PubMed  Google Scholar 

  44. Adrie C, Cariou A, Mourvillier B, Laurent I, Dabbane H, Hantala F, et al. Predicting survival with good neurological recovery at hospital admission after successful resuscitation of out-of-hospital cardiac arrest: the OHCA score. Eur Heart J. 2006;27(23):2840–5.

    PubMed  Google Scholar 

  45. Bougouin W, Lamhaut L, Marijon E, Jost D, Dumas F, Deye N, et al. Characteristics and prognosis of sudden cardiac death in greater Paris: population-based approach from the Paris sudden death expertise center (Paris-SDEC). Intensive Care Med. 2014;40(6):846–54.

    PubMed  Google Scholar 

  46. Grasner JT, Meybohm P, Lefering R, Wnent J, Bahr J, Messelken M, et al. ROSC after cardiac arrest—the RACA score to predict outcome after out-of-hospital cardiac arrest. Eur Heart J. 2011;32(13):1649–56.

    PubMed  Google Scholar 

  47. Marijon E, Bougouin W, Celermajer DS, Perier MC, Dumas F, Benameur N, et al. Characteristics and outcomes of sudden cardiac arrest during sports in women. Circ Arrhythm Electrophysiol. 2013;6(6):1185–91.

    PubMed  Google Scholar 

  48. Marijon E, Bougouin W, Perier MC, Celermajer DS, Jouven X. Incidence of sports-related sudden death in France by specific sports and sex. JAMA. 2013;310(6):642–3.

    CAS  PubMed  Google Scholar 

  49. Airaksinen KE, Ikaheimo MJ, Linnaluoto M, Tahvanainen KU, Huikuri HV. Gender difference in autonomic and hemodynamic reactions to abrupt coronary occlusion. J Am Coll Cardiol. 1998;31(2):301–6.

    CAS  PubMed  Google Scholar 

  50. Marijon E, Uy-Evanado A, Dumas F, Karam N, Reinier K, Teodorescu C, et al. Warning symptoms are associated with survival from sudden cardiac arrest. Ann Intern Med. 2016;164(1):23–9.

    PubMed  PubMed Central  Google Scholar 

  51. Marijon E, Bougouin W, Karam N, Beganton F, Lamhaut L, Perier MC, et al. Survival from sports-related sudden cardiac arrest: In sports facilities versus outside of sports facilities. Am Heart J. 2015;170(2):339–45 e1.

    PubMed  Google Scholar 

  52. Rea TD, Eisenberg MS, Becker LJ, Murray JA, Hearne T. Temporal trends in sudden cardiac arrest: a 25-year emergency medical services perspective. Circulation. 2003;107(22):2780–5.

    PubMed  Google Scholar 

  53. Karam N, Narayanan K, Bougouin W, Benameur N, Beganton F, Jost D, et al. Major regional differences in automated external defibrillator placement and basic life support training in France: further needs for coordinated implementation. Resuscitation. 2017;118:49–54.

    PubMed  Google Scholar 

  54. Karam N, Pechmajou L, Marijon E, Jouven X. How often does athlete sudden cardiac death occur outside the context of exertion? J Am Coll Cardiol. 2016;68(19):2125–6.

    PubMed  Google Scholar 

  55. Drezner JA, Toresdahl BG, Rao AL, Huszti E, Harmon KG. Outcomes from sudden cardiac arrest in US high schools: a 2-year prospective study from the National Registry for AED use in sports. Br J Sports Med. 2013;47(18):1179–83.

    PubMed  Google Scholar 

  56. Halkin A, Steinvil A, Rosso R, Adler A, Rozovski U, Viskin S. Preventing sudden death of athletes with electrocardiographic screening: what is the absolute benefit and how much will it cost? J Am Coll Cardiol. 2012;60(22):2271–6.

    PubMed  Google Scholar 

  57. Borjesson M, Urhausen A, Kouidi E, Dugmore D, Sharma S, Halle M, et al. Cardiovascular evaluation of middle-aged/senior individuals engaged in leisure-time sport activities: position stand from the sections of exercise physiology and sports cardiology of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil. 2011;18(3):446–58.

    PubMed  Google Scholar 

  58. Corrado D, Pelliccia A, Bjornstad HH, Vanhees L, Biffi A, Borjesson M, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus statement of the study Group of Sport Cardiology of the working Group of Cardiac Rehabilitation and Exercise Physiology and the working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26(5):516–24.

    PubMed  Google Scholar 

  59. Mont L, Pelliccia A, Sharma S, Biffi A, Borjesson M, Brugada Terradellas J, et al. 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. Eur J Prev Cardiol. 2017;24(1):41–69.

    PubMed  Google Scholar 

  60. Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, et al. International recommendations for electrocardiographic interpretation in athletes. J Am Coll Cardiol. 2017;69(8):1057–75.

    PubMed  Google Scholar 

  61. Wheeler MT, Heidenreich PA, Froelicher VF, Hlatky MA, Ashley EA. Cost-effectiveness of preparticipation screening for prevention of sudden cardiac death in young athletes. Ann Intern Med. 2010;152(5):276–86.

    PubMed  PubMed Central  Google Scholar 

  62. Corrado D, Schmied C, Basso C, Borjesson M, Schiavon M, Pelliccia A, et al. Risk of sports: do we need a pre-participation screening for competitive and leisure athletes? Eur Heart J. 2011;32(8):934–44.

    PubMed  Google Scholar 

  63. Karam N, Marijon E, Jouven X. Opening a new front in the fight against sudden cardiac death: is it time for near-term prevention? Int J Cardiol. 2017;237:10–2.

    PubMed  Google Scholar 

  64. Marijon E, Bougouin W, Celermajer DS, Perier MC, Benameur N, Lamhaut L, et al. Major regional disparities in outcomes after sudden cardiac arrest during sports. Eur Heart J. 2013;34(47):3632–40.

    PubMed  Google Scholar 

  65. Girotra S, van Diepen S, Nallamothu BK, Carrel M, Vellano K, Anderson ML, et al. Regional variation in out-of-hospital cardiac arrest survival in the United States. Circulation. 2016;133(22):2159–68.

    PubMed  PubMed Central  Google Scholar 

  66. Borjesson M, Dugmore D, Mellwig KP, van Buuren F, Serratosa L, Solberg EE, et al. Time for action regarding cardiovascular emergency care at sports arenas: a lesson from the Arena study. Eur Heart J. 2010;31(12):1438–41.

    PubMed  Google Scholar 

  67. Borjesson M, Serratosa L, Carre F, Corrado D, Drezner J, Dugmore DL, et al. Consensus document regarding cardiovascular safety at sports arenas: position stand from the European Association of Cardiovascular Prevention and Rehabilitation (EACPR), section of sports cardiology. Eur Heart J. 2011;32(17):2119–24.

    PubMed  Google Scholar 

  68. Page RL, Husain S, White LY, Rea TD, Fahrenbruch C, Yin L, et al. Cardiac arrest at exercise facilities: implications for placement of automated external defibrillators. J Am Coll Cardiol. 2013;62(22):2102–9.

    PubMed  Google Scholar 

  69. Lebreton G, Pozzi M, Luyt CE, Chastre J, Carli P, Pavie A, et al. Out-of-hospital extra-corporeal life support implantation during refractory cardiac arrest in a half-marathon runner. Resuscitation. 2011;82(9):1239–42.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France

    Xavier Jouven, Kumar Narayanan & Eloi Marijon

  2. Paris Descartes University, Paris, France

    Xavier Jouven & Eloi Marijon

  3. Cardiology Department, European Georges Pompidou Hospital, Paris, France

    Xavier Jouven & Eloi Marijon

  4. Paris-Cardiovascular Research Center (Inserm U970), Paris, France

    Xavier Jouven & Eloi Marijon

  5. Cardiology Department, Medicover Hospitals, Hyderabad, India

    Kumar Narayanan

Authors
  1. Xavier Jouven
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kumar Narayanan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eloi Marijon
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Private Center for Sports and Exercise Cardiology, München, Bayern, Germany

    Axel Pressler

  2. University Institute of Sports Medicine Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria

    Josef Niebauer

Review

Review

1.1 Questions

  1. 1.

    A 45-year-old male with diagnosed coronary artery disease recently underwent coronary angiography and stenting. He is presently asymptomatic. He seeks your advice regarding playing recreational tennis in the evenings, as he is worried after reading about instances of people dying suddenly while playing. Would you advise him to play sports?

  2. 2.

    The owner of a fitness center chain contacts you for advice as there was a recent case of a person having a sudden cardiac arrest while exercising in one of his facilities. He asks you to suggest some measures which would be useful to prevent such events in the future. What are some practically useful measures which you can suggest?

1.2 Answers

  1. 1.

    Yes. While there is a transient small risk of SCD associated with vigorous physical activity, this should not overshadow the fact that regular exercise/sports have irrefutable cardiovascular benefits. Therefore, a blanket prohibition of sports in this case is not warranted. However, a thorough discussion and patient education is mandatory, with advice to gradually build up the activity level and to pay attention to any warning symptoms during exercise which can often precede an SCD event.

  2. 2.

    Strategies to prevent sports related SCD include targeted screening of individuals, public education and better AED access. Some practical measures which the fitness chain owner can implement could include arranging educational talks by experts for participants in the centers, focusing on cardiovascular prevention, early evaluation of any potential symptoms and also stressing the importance of early response in case of a witnessed cardiac arrest. Training in CPR can be arranged for interested volunteers and lastly AEDs can be made available in all centers. These strategies should help reduce instances of SCD during exercise and improve rates of bystander CPR and early AED use, two key determinants of survival after SCD.

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Jouven, X., Narayanan, K., Marijon, E. (2020). Incidence and Causes of Sudden Cardiac Death in Recreational Athletes. In: Pressler, A., Niebauer, J. (eds) Textbook of Sports and Exercise Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-35374-2_30

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-35374-2_30

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-35373-5

  • Online ISBN: 978-3-030-35374-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation