Sudden Death in Young Athletes

  • Domenico Corrado
  • Cristina Basso
  • Gaetano Thiene


Although sudden death during sport is a rare event, it always has a tragic impact because it occurs in apparently healthy individuals and assumes great visibility through the news media, due to the high public profile of competitive athletes [1, 2, 3, 4]. For centuries it was a mystery why cardiac arrest should occur in vigorous athletes, who had previously achieved extraordinary exercise performance without any symptoms. The cause was generally ascribed to myocardial infarction, even though evidence of ischemic myocardial necrosis was rarely reported. It is now clear that the most common mechanism of sudden death during sports activity is an abrupt ventricular tachyarrhythmia as a consequence of a wide spectrum of cardiovascular diseases, either acquired or congenital [2, 4, 5]. The culprit diseases are often clinically silent and unlikely to be suspected or diagnosed on the basis of spontaneous symptoms. Systematic cardiovascular screening (including 12-lead ECG) of all subjects embarking in sports activity has the potential to identify those athletes at risk and to reduce mortality [6].


Sudden Death Right Ventricle Hypertrophic Cardiomyopathy Young Athlete Ventricular Cardiomyopathy 
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  1. 1.
    Maron BJ, Roberts WC, McAllister MA et al (1980) Sudden death in young athletes. Circulation 62:218–229PubMedGoogle Scholar
  2. 2.
    Corrado D, Thiene G, Nava A et al (1990) Sudden death in young competitive athletes: Clinico-pathologic correlations in 22 cases. Am J Med 89:588–596PubMedCrossRefGoogle Scholar
  3. 3.
    Maron BJ (2003) Sudden death in young athletes. New Engl J Med 349:1064–1075PubMedCrossRefGoogle Scholar
  4. 4.
    Corrado D, Basso C, Thiene G (2005) Sudden death in young athletes. Lancet S47–S48Google Scholar
  5. 5.
    Basso C, Frescura C, Corrado D et al (1995) Congenital heart disease and sudden death in the young. Hum Path 26:1065–1072PubMedCrossRefGoogle Scholar
  6. 6.
    Corrado D, Basso C, Schiavon M et al (1998) Screening for hypertrophic cardiomyopathy in young athletes. New Engl J Med 339:364–369PubMedCrossRefGoogle Scholar
  7. 7.
    Thiene G, Nava A, Corrado D et al (1988) Right ventricular cardiomyopathy and sudden death in young people. N Engl J Med 318:129–133PubMedCrossRefGoogle Scholar
  8. 8.
    Basso C, Thiene G, Corrado D et al (1996) Arrhythmogenic right ventricular cardiomyopathy. Dysplasia, dystrophy, or myocarditis? Circulation 94:983–989PubMedGoogle Scholar
  9. 9.
    Corrado D, Basso C, Thiene G et al (1997) Spectrum of clinicopathologic manifestations of arrhythmogenic right ventricular cardiomyopathy/dysplasia: A multicenter study. J Am Coll Cardiol 30:1512–1520PubMedCrossRefGoogle Scholar
  10. 10.
    Van Camp SP, Bloor CM, Mueller FO et al (1995) Nontraumatic sports death in high school and college athletes. Med Sci Sports Exerc 27:641–647PubMedGoogle Scholar
  11. 11.
    Maron BJ, Gohman TE, Aeppli D. (1998) Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes. J Am Coll Cardiol 32:1881–1884PubMedCrossRefGoogle Scholar
  12. 12.
    Corrado D, Basso C, Rizzoli G et al (2003) Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol 42:1959–1963PubMedCrossRefGoogle Scholar
  13. 13.
    Thompson PD, Funk EJ, Carleton RA et al (1982) Incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA 247:2535–2538PubMedCrossRefGoogle Scholar
  14. 14.
    Burke AP, Farb A, Malcom GT et al (1999) Plaque rupture and sudden death related to exertion in men with coronary artery disease. JAMA 281:921–926PubMedCrossRefGoogle Scholar
  15. 15.
    Giri S, Thompson PD, Kiernan FJ et al (1999) Clinical and angiographic characteristics of exertion-related acute myocardial infarction. JAMA 282:1731–1736PubMedCrossRefGoogle Scholar
  16. 16.
    Corrado D, Basso C, Poletti A et al (1994) Sudden death in the young: Is coronary thrombosis the major precipitating factor? Circulation 90:2315–2323PubMedGoogle Scholar
  17. 17.
    Burke AP, Farb A, Virmani R et al (1991) Sports-related and non-sports-related sudden cardiac death in young adults. Am Heart J 121:568–575PubMedCrossRefGoogle Scholar
  18. 18.
    Basso C, Maron BJ, Corrado D et al (2000) Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 35:1493–1501PubMedCrossRefGoogle Scholar
  19. 19.
    Basso C, Thiene G, Corrado D et al (2000) Hypertrophic cardiomyopathy: Pathologic evidence of ischemic damage in young sudden death victims. Hum Pathol 31:988–998PubMedCrossRefGoogle Scholar
  20. 20.
    Basso C, Corrado D, Rossi L et al (2001) Ventricular preexcitation in children and young adults: Atrial myocarditis as a possible trigger of sudden death. Circulation 103:269–275PubMedGoogle Scholar
  21. 21.
    Corrado D, Basso C, Buja G et al (2001) Right bundle branch block, right precordial ST-segment elevation, and sudden death in young people. Circulation 103:710–717PubMedGoogle Scholar
  22. 22.
    Corrado D, Basso C, Thiene G (2001) Sudden cardiac death in young people with apparently normal heart. Cardiovasc Res 50:399–408PubMedCrossRefGoogle Scholar
  23. 23.
    Wilde AA, Antzelevitch C, Borggrefe M et al (2002) Study Group on the Molecular Basis of Arrhythmias of the European Society of Cardiology. Proposed diagnostic criteria for the Brugada syndrome: Consensus report. Circulation 106:2514–2519PubMedCrossRefGoogle Scholar
  24. 24.
    Corrado D, Pelliccia A, Antzelevitch C et al (2005) ST segment elevation and sudden death in the athlete. In: Antzelevitch C, Brugada P (eds) The Brugada syndrome: From bench to bedside. Blackwell Futura, Oxford, pp 119–129Google Scholar
  25. 25.
    Maron BJ, Gohman TE, Kyle SB et al (2002) Clinical profile and spectrum of commotio cordis. JAMA 287:1142–1146PubMedCrossRefGoogle Scholar
  26. 26.
    Corrado D, Thiene G (2006) Arrhythmogenic right ventricular cardiomyopathy/dysplasia: Clinical impact of molecular genetic studies. Circulation 113:1634–1637PubMedCrossRefGoogle Scholar
  27. 27.
    Gerull B, Heuser A, Wichter T et al (2004) Mutations in the desmosomal protein plakophilin-2 are common in arrhythmogenic right ventricular cardiomyopathy. Nat Genet 36:1162–1164PubMedCrossRefGoogle Scholar
  28. 28.
    Basso C, Czarnowska E, Della Barbera M et al (2006) Ultrastructural evidence of intercalated disc remodelling in arrhythmogenic right ventricular cardiomyopathy: An electron microscopy investigation on endomyocardial biopsies. Eur Heart J 27:1847–1845PubMedCrossRefGoogle Scholar
  29. 29.
    Corrado D, Leoni L, Link MS et al (2003) Implantable cardioverter-defibrillator therapy for prevention of sudden death in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation 108:3084–3091PubMedCrossRefGoogle Scholar
  30. 30.
    Douglas PS, O’Toole ML, Hiller WDB et al (1990) Different effects of prolonged exercise on the right and left ventricles. J Am Coll Cardiol 15:64–69PubMedCrossRefGoogle Scholar
  31. 31.
    Kirchhof P, Fabritz L, Zwiener M et al (2006) Age-and training-dependent development of arrhythmogenic right ventricular cardiomyopathy in heterozygous plakoglobin-deficient mice. Circulation 114:1799–1806PubMedCrossRefGoogle Scholar
  32. 32.
    Wichter T, Hindricks G, Lerch H et al (1994) Regional myocardial sympathetic dysinnervation in arrhythmogenic right ventricular cardiomyopathy. Circulation 89:667–683PubMedGoogle Scholar
  33. 33.
    Tiso N, Stephan DA, Nava A et al (2001) Identification of mutations in the cardiac ryanodine receptor gene in families affected with arrhythmogenic right ventricular cardiomyopathy type 2 (ARVD2). Hum Mol Genet 10:189–194PubMedCrossRefGoogle Scholar
  34. 34.
    Priori SG, Napolitano C, Tiso N et al (2000) Mutations in the cardiac ryanodine receptor gene (hryr2) underlie catecholaminergic polymorphic ventricular tachycardia. Circulation 103:196–200Google Scholar
  35. 35.
    Marcus F, Fontaine G, Guiraudon G et al (1982) Right ventricular dysplasia: A report of 24 adult cases. Circulation 65:384–398PubMedGoogle Scholar
  36. 36.
    Corrado D, Fontaine G, Marcus FI et al (2000) Arrhythmogenic right ventricular dysplasia/cardiomyopathy: Need for an international registry. Study Group on Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy of the Working Groups on Myocardial and Pericardial Disease and Arrhythmias of the European Society of Cardiology and of the Scientific Council on Cardiomyopathies of the World Heart Federation. Circulation 101:E101–E106PubMedGoogle Scholar
  37. 37.
    Corrado D, Basso C, Thiene G et al (2000) Arrhythmogenic right ventricular cardiomyopathy: Diagnosis, prognosis, and treatment. Heart 83:588–595PubMedCrossRefGoogle Scholar
  38. 38.
    Turrini P, Corrado D, Basso C et al (2001) Dispersion of ventricular depolarization-repolarization: A noninvasive marker for risk stratification in arrhythmogenic right ventricular cardiomyopathy. Circulation 103:3075–3080PubMedGoogle Scholar
  39. 39.
    Corrado D, Basso C, Fontaine G et al (2002) Clinical profile of young competitive athletes who died suddenly of arrhythmogenic right ventricular cardiomyopathy/dysplasia: A multicenter study. PACE 24:544 (abstr.)Google Scholar
  40. 40.
    Marcus FI (2005) Prevalence of T-wave inversion beyond V1 in young normal individuals and usefulness for the diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia. Am J Cardiol 95:1070–1071PubMedCrossRefGoogle Scholar
  41. 41.
    Corrado D, Pelliccia A, Bjornstad HH et al (2005) 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 26:516–524PubMedCrossRefGoogle Scholar
  42. 42.
    Corrado D, Basso C, Pavei A et al (2006) Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 296:1593–1601PubMedCrossRefGoogle Scholar
  43. 43.
    Maron BJ, Pelliccia A, Spirito P (1995) Cardiac disease in young trained athletes. Insights into methods for distinguishing athlete’s heart from structural heart disease, with particular emphasis on hypertrophic cardiomyopathy. Circulation 91:1596–1601PubMedGoogle Scholar
  44. 44.
    Maron BJ, Zipes DP (2005) 36th Bethesda Conference: Recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities. J Am Coll Cardiol 45:1373–1375PubMedCrossRefGoogle Scholar
  45. 45.
    Pelliccia A, Fagard R, Bjornstad HH et al (2005) Recommendations for competitive sports participation in athletes with cardiovascular disease: A consensus document from the Study Group of Sports 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 26:1422–1445PubMedCrossRefGoogle Scholar
  46. 46.
    Drezner JA, Rogers KJ (2006) Sudden cardiac arrest in intercollegiate athletes: Detailed analysis and outcomes of resuscitation in nine cases. Heart Rhythm 3:755–759PubMedCrossRefGoogle Scholar
  47. 47.
    Maron BJ, Chaitman BR, Ackerman MJ et al (2004) Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation 109:2807–2816PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Domenico Corrado
    • 1
  • Cristina Basso
    • 2
  • Gaetano Thiene
    • 2
  1. 1.Department of Cardiological, Thoracic and Vascular SciencesUniversity of PaduaItaly
  2. 2.Department of Medical Diagnostic SciencesUniversity of PaduaItaly

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