Sudden Cardiac Death As a Mystery of The Sports World - Current Insight Into Risk Factors, Diagnosis and Management of The Most Common Underlying Causes
DOI:
https://doi.org/10.12775/QS.2025.46.66494Keywords
Sudden cardiac death, Sudden cardiac arrest, Sudden cardiac death in sport, Sudden cardiac death in athletesAbstract
Introduction and aim of the study: With the growing popularity of physical activity, sudden cardiac death has become a significant concern among both professional and recreational athletes. This study aims to review current knowledge on risk factors, diagnosis, and management of the most common causes of sudden cardiac arrest and sudden cardiac death in athletes, offering practical insights for healthcare professionals.
Materials and methods: This review is based on literature sourced from databases such as PubMed and Google Scholar. Keywords used included: “sudden cardiac death,” “sudden cardiac arrest,” “sudden cardiac death in sport,” and “sudden cardiac death in athletes.”
Results: Several risk factors for sudden cardiac death were identified, including age, sex, ethnicity, type and intensity of sport, and abnormalities on ECG screening. The causes of sudden cardiac death vary by age; in athletes under 35, the most frequent conditions include hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, and Brugada syndrome. These conditions were analyzed with respect to diagnosis, management, and potential complications.
Conclusion: Sudden cardiac arrest and sudden cardiac death are critical concerns in the athletic population. All discussed conditions are genetically determined, so a family history of unexplained sudden death or cardiogenic syncope should raise clinical suspicion. Early detection, proper risk assessment, and timely intervention can significantly reduce the risk of fatal outcomes. Increasing physician awareness of these conditions is essential to improve recognition and prevention among at-risk athletes.
References
[1] A.G. Yow, V. Rajasurya, I. Ahmed, S. Sharma, Sudden Cardiac Death, StatPearls Publishing, 2025. http://www.ncbi.nlm.nih.gov/pubmed/36880552 (accessed July 5, 2025).
[2] C.H. Landry, K.S. Allan, K.A. Connelly, K. Cunningham, L.J. Morrison, P. Dorian, Rescu Investigators, Sudden Cardiac Arrest during Participation in Competitive Sports., N. Engl. J. Med. 377 (2017) 1943–1953. https://doi.org/10.1056/NEJMoa1615710.
[3] M. Ackerman, D.L. Atkins, J.K. Triedman, Sudden Cardiac Death in the Young., Circulation. 133 (2016) 1006–26. https://doi.org/10.1161/CIRCULATIONAHA.115.020254.
[4] G. Finocchiaro, M. Papadakis, J.-L. Robertus, H. Dhutia, A.K. Steriotis, M. Tome, G. Mellor, A. Merghani, A. Malhotra, E. Behr, S. Sharma, M.N. Sheppard, Etiology of Sudden Death in Sports: Insights From a United Kingdom Regional Registry., J. Am. Coll. Cardiol. 67 (2016) 2108–2115. https://doi.org/10.1016/j.jacc.2016.02.062.
[5] B. Melnyk, A. Rygielski, E. Latour, M. Latour, R. Judek, M. Melnyk, Sudden Cardiac Death in Athletes: Magnitude, Causes, and Prevention Strategies - A Literature Review, Qual. Sport. 19 (2024) 54350. https://doi.org/10.12775/QS.2024.19.54350.
[6] A. Kumar, D.M. Avishay, C.R. Jones, J.D. Shaikh, R. Kaur, M. Aljadah, A. Kichloo, N. Shiwalkar, S. Keshavamurthy, Sudden cardiac death: epidemiology, pathogenesis and management., Rev. Cardiovasc. Med. 22 (2021) 147–158. https://doi.org/10.31083/j.rcm.2021.01.207.
[7] D. Corrado, C. Basso, M. Schiavon, G. Thiene, Screening for hypertrophic cardiomyopathy in young athletes., N. Engl. J. Med. 339 (1998) 364–9. https://doi.org/10.1056/NEJM199808063390602.
[8] Z. Kafara, D. Jurczak, A. Jonczyk, T. Ambroży, R. Muszkieta, R. Makuch, Causes of sudden cardiac death in professional athletes, Qual. Sport. 39 (2025) 59201. https://doi.org/10.12775/QS.2025.39.59201.
[9] J. Han, A. Lalario, E. Merro, G. Sinagra, S. Sharma, M. Papadakis, G. Finocchiaro, Sudden Cardiac Death in Athletes: Facts and Fallacies., J. Cardiovasc. Dev. Dis. 10 (2023). https://doi.org/10.3390/jcdd10020068.
[10] D. Corrado, C. Basso, G. Rizzoli, M. Schiavon, G. Thiene, Does sports activity enhance the risk of sudden death in adolescents and young adults?, J. Am. Coll. Cardiol. 42 (2003) 1959–63. https://doi.org/10.1016/j.jacc.2003.03.002.
[11] G. Finocchiaro, J. Westaby, R. Bhatia, A. Malhotra, E.R. Behr, M. Papadakis, S. Sharma, M.N. Sheppard, Sudden Death in Female Athletes: Insights From a Large Regional Registry in the United Kingdom., Circulation. 144 (2021) 1827–1829. https://doi.org/10.1161/CIRCULATIONAHA.121.055535.
[12] M.A.E. Haukilahti, L. Holmström, J. Vähätalo, T. Kenttä, J. Tikkanen, L. Pakanen, M.-L. Kortelainen, J. Perkiömäki, H. Huikuri, R.J. Myerburg, M.J. Junttila, Sudden Cardiac Death in Women., Circulation. 139 (2019) 1012–1021. https://doi.org/10.1161/CIRCULATIONAHA.118.037702.
[13] D.F. Peterson, K. Kucera, L.C. Thomas, J. Maleszewski, D. Siebert, M. Lopez-Anderson, M. Zigman, J. Schattenkerk, K.G. Harmon, J.A. Drezner, Aetiology and incidence of sudden cardiac arrest and death in young competitive athletes in the USA: a 4-year prospective study., Br. J. Sports Med. 55 (2021) 1196–1203. https://doi.org/10.1136/bjsports-2020-102666.
[14] A. Malhotra, H. Dhutia, G. Finocchiaro, S. Gati, I. Beasley, P. Clift, C. Cowie, A. Kenny, J. Mayet, D. Oxborough, K. Patel, G. Pieles, D. Rakhit, D. Ramsdale, L. Shapiro, J. Somauroo, G. Stuart, A. Varnava, J. Walsh, Z. Yousef, M. Tome, M. Papadakis, S. Sharma, Outcomes of Cardiac Screening in Adolescent Soccer Players., N. Engl. J. Med. 379 (2018) 524–534. https://doi.org/10.1056/NEJMoa1714719.
[15] F. Sollazzo, V. Palmieri, S.F. Gervasi, F. Cuccaro, G. Modica, M.L. Narducci, G. Pelargonio, P. Zeppilli, M. Bianco, Sudden Cardiac Death in Athletes in Italy during 2019: Internet-Based Epidemiological Research., Medicina (Kaunas). 57 (2021). https://doi.org/10.3390/medicina57010061.
[16] A.S. Adabag, R. V Luepker, V.L. Roger, B.J. Gersh, Sudden cardiac death: epidemiology and risk factors., Nat. Rev. Cardiol. 7 (2010) 216–25. https://doi.org/10.1038/nrcardio.2010.3.
[17] M. Hayashi, W. Shimizu, C.M. Albert, The spectrum of epidemiology underlying sudden cardiac death., Circ. Res. 116 (2015) 1887–906. https://doi.org/10.1161/CIRCRESAHA.116.304521.
[18] R. Margey, A. Roy, S. Tobin, C.J. O’Keane, C. McGorrian, V. Morris, S. Jennings, J. Galvin, Sudden cardiac death in 14- to 35-year olds in Ireland from 2005 to 2007: a retrospective registry., Europace. 13 (2011) 1411–8. https://doi.org/10.1093/europace/eur161.
[19] R. Puranik, C.K. Chow, J.A. Duflou, M.J. Kilborn, M.A. McGuire, Sudden death in the young., Hear. Rhythm. 2 (2005) 1277–82. https://doi.org/10.1016/j.hrthm.2005.09.008.
[20] D. Corrado, C. Basso, G. Thiene, Sudden cardiac death in young people with apparently normal heart., Cardiovasc. Res. 50 (2001) 399–408. https://doi.org/10.1016/s0008-6363(01)00254-1.
[21] P. Teekakirikul, W. Zhu, H.C. Huang, E. Fung, Hypertrophic Cardiomyopathy: An Overview of Genetics and Management., Biomolecules. 9 (2019). https://doi.org/10.3390/biom9120878.
[22] P. Richard, P. Charron, L. Carrier, C. Ledeuil, T. Cheav, C. Pichereau, A. Benaiche, R. Isnard, O. Dubourg, M. Burban, J.-P. Gueffet, A. Millaire, M. Desnos, K. Schwartz, B. Hainque, M. Komajda, EUROGENE Heart Failure Project, Hypertrophic cardiomyopathy: distribution of disease genes, spectrum of mutations, and implications for a molecular diagnosis strategy., Circulation. 107 (2003) 2227–32. https://doi.org/10.1161/01.CIR.0000066323.15244.54.
[23] E. Authors/Task Force members, P.M. Elliott, A. Anastasakis, M.A. Borger, M. Borggrefe, F. Cecchi, P. Charron, A.A. Hagege, A. Lafont, G. Limongelli, H. Mahrholdt, W.J. McKenna, J. Mogensen, P. Nihoyannopoulos, S. Nistri, P.G. Pieper, B. Pieske, C. Rapezzi, F.H. Rutten, C. Tillmanns, H. Watkins, 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC)., Eur. Heart J. 35 (2014) 2733–79. https://doi.org/10.1093/eurheartj/ehu284.
[24] B.J. Maron, A. Pelliccia, P. Spirito, 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 (1995) 1596–601. https://doi.org/10.1161/01.cir.91.5.1596.
[25] Y. Zhang, M. Adamo, C. Zou, A. Porcari, D. Tomasoni, M. Rossi, M. Merlo, H. Liu, J. Wang, P. Zhou, M. Metra, G. Sinagra, J. Zhang, Management of hypertrophic cardiomyopathy., J. Cardiovasc. Med. (Hagerstown). 25 (2024) 399–419. https://doi.org/10.2459/JCM.0000000000001616.
[26] M. V Sherrid, I. Barac, W.J. McKenna, P.M. Elliott, S. Dickie, L. Chojnowska, S. Casey, B.J. Maron, Multicenter study of the efficacy and safety of disopyramide in obstructive hypertrophic cardiomyopathy., J. Am. Coll. Cardiol. 45 (2005) 1251–8. https://doi.org/10.1016/j.jacc.2005.01.012.
[27] M. Zampieri, A. Argirò, A. Marchi, M. Berteotti, M. Targetti, A. Fornaro, A. Tomberli, P. Stefàno, N. Marchionni, I. Olivotto, Mavacamten, a Novel Therapeutic Strategy for Obstructive Hypertrophic Cardiomyopathy., Curr. Cardiol. Rep. 23 (2021) 79. https://doi.org/10.1007/s11886-021-01508-0.
[28] M.M. Sanghvi, E. Dhall, C.A.A. Chahal, C. O’Mahony, S.A. Mohiddin, K. Savvatis, F. Ricci, P.B. Munroe, S.E. Petersen, N. Aung, M.Y. Khanji, Hypertrophic cardiomyopathy management: a systematic review of the clinical practice guidelines and recommendations., Eur. Hear. Journal. Qual. Care Clin. Outcomes. (2025). https://doi.org/10.1093/ehjqcco/qcae117.
[29] A.D. Krahn, A.A.M. Wilde, H. Calkins, A. La Gerche, J. Cadrin-Tourigny, J.D. Roberts, H.-C. Han, Arrhythmogenic Right Ventricular Cardiomyopathy., JACC. Clin. Electrophysiol. 8 (2022) 533–553. https://doi.org/10.1016/j.jacep.2021.12.002.
[30] A. Bhonsale, A.S.J.M. Te Riele, A.C. Sawant, J.A. Groeneweg, C.A. James, B. Murray, C. Tichnell, T.P. Mast, M.J. van der Pols, M.J.M. Cramer, D. Dooijes, J.F. van der Heijden, H. Tandri, J.P. van Tintelen, D.P. Judge, R.N.W. Hauer, H. Calkins, Cardiac phenotype and long-term prognosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia patients with late presentation., Hear. Rhythm. 14 (2017) 883–891. https://doi.org/10.1016/j.hrthm.2017.02.013.
[31] R. Cardona-Guarache, M. Åström-Aneq, A. Oesterle, R. Asirvatham, J. Svetlichnaya, G.M. Marcus, E.P. Gerstenfeld, L. Klein, M.M. Scheinman, Atrial arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy: Prevalence, echocardiographic predictors, and treatment., J. Cardiovasc. Electrophysiol. 30 (2019) 1801–1810. https://doi.org/10.1111/jce.14069.
[32] D. Corrado, T. Wichter, M.S. Link, R. Hauer, F. Marchlinski, A. Anastasakis, B. Bauce, C. Basso, C. Brunckhorst, A. Tsatsopoulou, H. Tandri, M. Paul, C. Schmied, A. Pelliccia, F. Duru, N. Protonotarios, N.A.M. Estes, W.J. McKenna, G. Thiene, F.I. Marcus, H. Calkins, Treatment of arrhythmogenic right ventricular cardiomyopathy/dysplasia: an international task force consensus statement., Eur. Heart J. 36 (2015) 3227–37. https://doi.org/10.1093/eurheartj/ehv162.
[33] W. Wang, G. Orgeron, C. Tichnell, B. Murray, J. Crosson, O. Monfredi, J. Cadrin-Tourigny, H. Tandri, H. Calkins, C.A. James, Impact of Exercise Restriction on Arrhythmic Risk Among Patients With Arrhythmogenic Right Ventricular Cardiomyopathy., J. Am. Heart Assoc. 7 (2018). https://doi.org/10.1161/JAHA.118.008843.
[34] W. Wang, C. Tichnell, B.A. Murray, J. Agafonova, J. Cadrin-Tourigny, S. Chelko, H. Tandri, H. Calkins, C.A. James, Exercise restriction is protective for genotype-positive family members of arrhythmogenic right ventricular cardiomyopathy patients., Europace. 22 (2020) 1270–1278. https://doi.org/10.1093/europace/euaa105.
[35] A.A.M. Wilde, A.S. Amin, P.G. Postema, Diagnosis, management and therapeutic strategies for congenital long QT syndrome., Heart. 108 (2022) 332–338. https://doi.org/10.1136/heartjnl-2020-318259.
[36] S.G. Priori, A.A. Wilde, M. Horie, Y. Cho, E.R. Behr, C. Berul, N. Blom, J. Brugada, C.-E. Chiang, H. Huikuri, P. Kannankeril, A. Krahn, A. Leenhardt, A. Moss, P.J. Schwartz, W. Shimizu, G. Tomaselli, C. Tracy, A. Document Reviewers, M. Ackerman, B. Belhassen, N.A.M. Estes, D. Fatkin, J. Kalman, E. Kaufman, P. Kirchhof, E. Schulze-Bahr, C. Wolpert, J. Vohra, M. Refaat, S.P. Etheridge, R.M. Campbell, E.T. Martin, S.C. Quek, Heart Rhythm Society, European Heart Rhythm Association, Asia Pacific Heart Rhythm Society, Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes., Europace. 15 (2013) 1389–406. https://doi.org/10.1093/europace/eut272.
[37] A.D. Krahn, Z. Laksman, R.W. Sy, P.G. Postema, M.J. Ackerman, A.A.M. Wilde, H.-C. Han, Congenital Long QT Syndrome., JACC. Clin. Electrophysiol. 8 (2022) 687–706. https://doi.org/10.1016/j.jacep.2022.02.017.
[38] K.E. Tobert, J.M. Bos, R. Garmany, M.J. Ackerman, Return-to-Play for Athletes With Long QT Syndrome or Genetic Heart Diseases Predisposing to Sudden Death., J. Am. Coll. Cardiol. 78 (2021) 594–604. https://doi.org/10.1016/j.jacc.2021.04.026.
[39] J. Ahn, H.J. Kim, J.-I. Choi, K.N. Lee, J. Shim, H.S. Ahn, Y.-H. Kim, Effectiveness of beta-blockers depending on the genotype of congenital long-QT syndrome: A meta-analysis., PLoS One. 12 (2017) e0185680. https://doi.org/10.1371/journal.pone.0185680.
[40] Y. Biton, S. Rosero, A.J. Moss, I. Goldenberg, V. Kutyifa, S. McNitt, B. Polonsky, J.R. Baman, W. Zareba, Primary prevention with the implantable cardioverter-defibrillator in high-risk long-QT syndrome patients., Europace. 21 (2019) 339–346. https://doi.org/10.1093/europace/euy149.
[41] P.J. Schwartz, S.G. Priori, M. Cerrone, C. Spazzolini, A. Odero, C. Napolitano, R. Bloise, G.M. De Ferrari, C. Klersy, A.J. Moss, W. Zareba, J.L. Robinson, W.J. Hall, P.A. Brink, L. Toivonen, A.E. Epstein, C. Li, D. Hu, Left cardiac sympathetic denervation in the management of high-risk patients affected by the long-QT syndrome., Circulation. 109 (2004) 1826–33. https://doi.org/10.1161/01.CIR.0000125523.14403.1E.
[42] A.D. Krahn, E.R. Behr, R. Hamilton, V. Probst, Z. Laksman, H.-C. Han, Brugada Syndrome., JACC. Clin. Electrophysiol. 8 (2022) 386–405. https://doi.org/10.1016/j.jacep.2021.12.001.
[43] A. Milman, A. Andorin, J.-B. Gourraud, F. Sacher, P. Mabo, S.-H. Kim, S. Maeda, Y. Takahashi, T. Kamakura, T. Aiba, G. Conte, J.J.M. Juang, E. Leshem, M. Rahkovich, A. Hochstadt, Y. Mizusawa, P.G. Postema, E. Arbelo, Z. Huang, I. Denjoy, C. Giustetto, Y.D. Wijeyeratne, C. Napolitano, Y. Michowitz, R. Brugada, R. Casado-Arroyo, J. Champagne, L. Calo, G. Sarquella-Brugada, J. Tfelt-Hansen, S.G. Priori, M. Takagi, C. Veltmann, P. Delise, D. Corrado, E.R. Behr, F. Gaita, G.-X. Yan, J. Brugada, A. Leenhardt, A.A.M. Wilde, P. Brugada, K.F. Kusano, K. Hirao, G.-B. Nam, V. Probst, B. Belhassen, Age of First Arrhythmic Event in Brugada Syndrome: Data From the SABRUS (Survey on Arrhythmic Events in Brugada Syndrome) in 678 Patients., Circ. Arrhythm. Electrophysiol. 10 (2017). https://doi.org/10.1161/CIRCEP.117.005222.
[44] M.H. Gollob, L. Blier, R. Brugada, J. Champagne, V. Chauhan, S. Connors, M. Gardner, M.S. Green, R. Gow, R. Hamilton, L. Harris, J.S. Healey, K. Hodgkinson, C. Honeywell, M. Kantoch, J. Kirsh, A. Krahn, M. Mullen, R. Parkash, D. Redfearn, J. Rutberg, S. Sanatani, A. Woo, Recommendations for the use of genetic testing in the clinical evaluation of inherited cardiac arrhythmias associated with sudden cardiac death: Canadian Cardiovascular Society/Canadian Heart Rhythm Society joint position paper., Can. J. Cardiol. 27 (2011) 232–45. https://doi.org/10.1016/j.cjca.2010.12.078.
[45] Q. Wu, H. Hayashi, D. Hira, K. Sonoda, S. Ueshima, S. Ohno, T. Makiyama, T. Terada, T. Katsura, K. Miura, M. Horie, Genetic variants of alcohol-metabolizing enzymes in Brugada syndrome: Insights into syncope after drinking alcohol., J. Arrhythmia. 35 (2019) 752–759. https://doi.org/10.1002/joa3.12227.
[46] I. Anguera, A. García-Alberola, P. Dallaglio, J. Toquero, L. Pérez, J.G. Martínez, R. Peinado, J.M. Rubín, J. Brugada, A. Cequier, Shock Reduction With Long-Term Quinidine in Patients With Brugada Syndrome and Malignant Ventricular Arrhythmia Episodes., J. Am. Coll. Cardiol. 67 (2016) 1653–1654. https://doi.org/10.1016/j.jacc.2016.01.042.
[47] L. Halperin, G. Mellor, M. Talajic, A. Krahn, R. Tadros, Z. Laksman, Quinidine effective for the management of ventricular and atrial arrhythmias associated with Brugada syndrome., Hear. Case Reports. 4 (2018) 270–272. https://doi.org/10.1016/j.hrcr.2018.01.008.
[48] A. Andorin, J.-B. Gourraud, J. Mansourati, S. Fouchard, H. le Marec, P. Maury, P. Mabo, J.-S. Hermida, J.-C. Deharo, B. Delasalle, S. Esnault, N. Sadoul, J.-M. Davy, A. Leenhardt, D. Klug, P. Defaye, D. Babuty, F. Sacher, V. Probst, The QUIDAM study: Hydroquinidine therapy for the management of Brugada syndrome patients at high arrhythmic risk., Hear. Rhythm. 14 (2017) 1147–1154. https://doi.org/10.1016/j.hrthm.2017.04.019.
[49] P. Maury, P. Couderc, M. Delay, S. Boveda, J. Brugada, Electrical storm in Brugada syndrome successfully treated using isoprenaline., Europace. 6 (2004) 130–3. https://doi.org/10.1016/j.eupc.2003.11.009.
[50] S.M. Al-Khatib, W.G. Stevenson, M.J. Ackerman, W.J. Bryant, D.J. Callans, A.B. Curtis, B.J. Deal, T. Dickfeld, M.E. Field, G.C. Fonarow, A.M. Gillis, C.B. Granger, S.C. Hammill, M.A. Hlatky, J.A. Joglar, G.N. Kay, D.D. Matlock, R.J. Myerburg, R.L. Page, 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Gui, Hear. Rhythm. 15 (2018) e190–e252. https://doi.org/10.1016/j.hrthm.2017.10.035.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Jakub Kędzia, Joanna Duda, Kinga Racisz, Paweł Racisz, Alicja Obcowska, Aleksandra Walendzik
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 144
Number of citations: 0
