Sports-Related Sudden Cardiac Arrest: Age and Sex Risk Factors

Abstract

Sports-related sudden cardiac arrest (SRSCA) is defined as a natural out-of-hospital collapse of presumed cardiac origin occurring during or within one hour of moderate-to-vigorous physical exercise. Despite the well-documented cardiovascular benefits of physical activity, vigorous exertion can transiently trigger life-threatening arrhythmias in vulnerable individuals, a phenomenon known as the "paradox of exercise". This scientific review aims to evaluate the combined influence of age and sex on the risk and clinical presentation of SRSCA by synthesizing high-quality evidence from contemporary literature, including 37 original research articles drawn from international registries such as the NCAA, FIFA, and ESCAPE-NET. The analysis reveals a striking and consistent male predominance, with men accounting for 90% to 98% of cases across various registries, while women exhibit a 10- to 13-fold lower incidence rate. Furthermore, the underlying pathological substrates shift significantly with age; inherited or congenital structural diseases like hypertrophic cardiomyopathy and coronary artery anomalies predominate in athletes under 35, whereas atherosclerotic coronary artery disease is the primary cause in those over 35. Survival rates following SRSCA are notably favorable compared to non-sports cardiac arrests, ranging from 45% to over 90% in organized settings, largely due to the witnessed nature of these events and the rapid utilization of automated external defibrillators (AEDs), which is associated with survival as high as 86%. Consequently, reducing the burden of sudden death requires a two-tier strategy: primary prevention through preparticipation screening initiated around age 12 to detect phenotypic manifestations of disease, and secondary prevention via robust emergency preparedness, including mandatory AED access and rehearsed emergency action plans at all sporting venues.