Sudden Cardiac Arrest in Athletes: Current Perspectives on Prevention and Emergency - A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.61.73091Keywords
Sudden Cardiac Arrest (SCA), Competitive Athletes, Sports Cardiology, Cardiovascular AbnormalitiesAbstract
Background: Sudden cardiac arrest (SCA) in athletes is a leading cause of exercise-related mortality driven by underlying cardiac substrates and exertional triggers.
Aim: The primary objective of this narrative review is to summarize and evaluate current evidence regarding the etiology, epidemiology, pathophysiology, and prevention strategies of SCA in athletes, while highlighting essential protocols for on-field emergency management.
Material and methods: This review synthesizes data from global registries and clinical studies to analyze SCA incidence, screening models, and survival outcomes.
Results: SCA incidence ranges from 1:40,000 to 1:80,000 athlete-years, with higher risks in male (5.55-fold) and Black athletes (nearly 3-fold). Primary causes include hypertrophic cardiomyopathy (36% of US fatalities) and coronary anomalies (12%–14%), triggered by exercise-induced adrenergic surges. The 2017 International Criteria for ECG have reduced false-positives to ~3%. Witnessed SCA with defibrillation within 3 minutes yields an 68%–89% survival rate, vastly outperforming the general population (8%–10%).
Conclusions: Preventing SCA mortality requires optimized screening, rehearsed venue Emergency Action Plans, immediate AED access, and genetic cascade screening for inherited conditions.
References
1. Malik A, Hanson J, Han J, Dolezal B, Bradfield JS, Boyle NG, et al. Sudden cardiac arrest in athletes and strategies to optimize preparedness. Clin Cardiol. 2023;46(9):1059-1071. https://doi.org/10.1002/clc.24095
2. Panhuyzen-Goedkoop NM, Wellens HJ, Piek JJ. Early recognition of sudden cardiac arrest in athletes during sports activity. Neth Heart J. 2018;26(1):21-25. https://doi.org/10.1007/s12471-017-1061-5
3. Rothmier JD, Drezner JA. The role of automated external defibrillators in athletics. Sports Health. 2009;1(1):16-20. https://doi.org/10.1177/1941738108326979
4. Vecchiato M, Egger F, Palermi S. Sporting Careers After ICD Implantation in Elite Athletes. J Cardiovasc Dev Dis. 2026;13(2):97. https://doi.org/10.3390/jcdd13020097
5. Peterson DF, Kucera K, Thomas LC, et al. 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. 2021;55(21):1196-1203. https://doi.org/10.1136/bjsports-2020-102666
6. Graziano F, Schiavon M, Cipriani A, et al. Causes of sudden cardiac arrest and death and the diagnostic yield of sport preparticipation screening in children. Br J Sports Med. 2024;58(5):255-260. https://doi.org/10.1136/bjsports-2023-107357
7. Kramer EB, Dvorak J, Schmied C, Meyer T. F-MARC: promoting the prevention and management of sudden cardiac arrest in football. Br J Sports Med. 2015;49(9):597-598. https://doi.org/10.1136/bjsports-2015-094764
8. Drezner JA, Peterson DF, Siebert DM, et al. Survival After Exercise-Related Sudden Cardiac Arrest in Young Athletes: Can We Do Better? Sports Health. 2019;11(1):91-98. https://doi.org/10.1177/1941738118799084
9. Edwards JJ, Compton C, Chatrath N, et al. International Criteria for Reporting Study Quality for Sudden Cardiac Arrest/Death Tool. J Am Heart Assoc. 2024;13(11):e033723. https://doi.org/10.1161/JAHA.123.033723
10. Lear A, Patel N, Mullen C, Simonson M, Leone V, Koshiaris C, et al. Incidence of Sudden Cardiac Arrest and Death in Young Athletes and Military Members: A Systematic Review and Meta-Analysis. J Athl Train. 2022;57(5):431-443. https://doi.org/10.4085/1062-6050-0748.20
11. Mason Z, Watson AM, Drezner JA. Emergency Preparedness for Sudden Cardiac Arrest in Amateur Athletic Union Basketball Teams: An Opportunity to Improve Outcomes in Higher Risk Athletes. Clin J Sport Med. 2022;32(6):617-619. https://doi.org/10.1097/JSM.0000000000001062
12. D'Ambrosio P, Claessen G, Kistler PM, Heidbuchel H, Kalman JM, La Gerche A. Ventricular arrhythmias in association with athletic cardiac remodelling. Europace. 2024;26(12):euae279. https://doi.org/10.1093/europace/euae279
13. Siebert DM, Drezner JA. Sudden cardiac arrest on the field of play: turning tragedy into a survivable event. Neth Heart J. 2018;26(3):115-119. https://doi.org/10.1007/s12471-018-1084-6
14. Żmigrodzka A, Przepióra A, Orłowska M, Kozłowska J, Sanocka M, Wielogórska A, et al. Sudden Cardiac Death (SCD) in Young Athletes – A Review of Current Guidelines and Key Studies. Qual Sport. 2026;54:70269. https://doi.org/10.12775/QS.2026.54.70269
15. Schattenkerk J, Kucera K, Peterson DF, Huggins RA, Drezner JA. Socioeconomic factors and outcomes from exercise-related sudden cardiac arrest in high school student-athletes in the USA. Br J Sports Med. 2022;56(3):138-143. https://doi.org/10.1136/bjsports-2021-104486
16. Ungaro S, Truglio TS, Zorzi A, et al. Sports-related sudden cardiac arrest: a video analysis of presenting features, management and outcomes. Br J Sports Med. 2026;60(1):20-27. https://doi.org/10.1136/bjsports-2025-110275
17. Baswaraj D, Flaker G. Syncope in Athletes: A Prelude to Sudden Cardiac Death? Mo Med. 2024;121(1):52-59.
18. Kim JH, Baggish AL, Levine BD, et al. Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2025;85(10):1059-1108. https://doi.org/10.1016/j.jacc.2024.12.025
19. Yano S, Katsumata Y, Muramoto Y, Kinoda A, Kimura T, Sato K, et al. Characteristics of Sudden Cardiac Arrest in Young Athletes: A Web-Based Survey of Athletes in Japanese College Sports. Cardiol Res Pract. 2025;2025:1265728. https://doi.org/10.1155/crp/1265728
20. Petek BJ, Churchill TW, Moulson N, et al. Survival Outcomes After Sudden Cardiac Arrest in Young Competitive Athletes From the United States. J Am Coll Cardiol. 2025;85(17):1682-1692. https://doi.org/10.1016/j.jacc.2025.03.006
21. Chhabra J, Voong T, Barnes G, Gaal W, Bratton A. Sideline Management of Sudden Cardiac Arrest. Video J Sports Med. 2025;5(2):26350254251329104. https://doi.org/10.1177/26350254251329104
22. Prakash K, Swarnakari KM, Bai M, et al. Sudden Cardiac Arrest in Athletes: A Primary Level of Prevention. Cureus. 2022;14(10):e30517. https://doi.org/10.7759/cureus.30517
23. Bassi MD, Farina JM, Bombau J, et al. Sudden Cardiac Arrest in Basketball and Soccer Stadiums, the Role of Automated External Defibrillators: A Review. Arrhythm Electrophysiol Rev. 2023;12:e03. https://doi.org/10.15420/aer.2022.30
24. Li L, Le Douairon Lahaye S, Ding S, Schnell F. Sex Differences in the Incidence of Sudden Cardiac Arrest/Death in Competitive Athletes: A Systematic Review and Meta-analysis. Sports Med. 2025;55(3):697-712. https://doi.org/10.1007/s40279-024-02163-5
25. Fanous Y, Dorian P. The prevention and management of sudden cardiac arrest in athletes. CMAJ. 2019;191(28):E787-E791. https://doi.org/10.1503/cmaj.190166
26. Abdallah AW, Nguyen D, Odeh O, et al. Cardiac Screening in Young Athletes: The Role of Diagnostics in Preventing Sudden Cardiac Death and Exploring Clearance Protocols. J Clin Med. 2026;15(5):1895. https://doi.org/10.3390/jcm15051895
27. Gray B, Semsarian C. Utility of genetic testing in athletes. Clin Cardiol. 2020;43(8):915-920. https://doi.org/10.1002/clc.23289
28. Carrington M, Providência R, Chahal CAA, et al. Cardiopulmonary Resuscitation and Defibrillator Use in Sports. Front Cardiovasc Med. 2022;9:819609. https://doi.org/10.3389/fcvm.2022.819609
29. Bohm P, Meyer T, Narayanan K, et al. Sports-related sudden cardiac arrest in young adults. Europace. 2023;25(2):627-633. https://doi.org/10.1093/europace/euac172
30. Siebert DM, Harmon KG. Looking Under the Hood: Screening for Cardiac Abnormalities in Young Athletes. Curr Rev Musculoskelet Med. 2025;19(1):2. https://doi.org/10.1007/s12178-025-09995-2
31. Edge CC, Collins JM, Avey MH, et al. On-Field Management: Cardiac Event. Video J Sports Med. 2025;5(2):26350254251326950. https://doi.org/10.1177/26350254251326950
32. Davis AJ, Orchard JW, Driscoll T, Orchard JJ. Chief medical officers' perceptions of athlete cardiac screening. JSAMS Plus. 2026;7:100138. https://doi.org/10.1016/j.jsampl.2026.100138
33. Konduri A, Lynn MM, Ezekian JE, Gaitonde M, Levine BD, Hansen K. Adolescent Athlete Returns to Competitive Basketball After Cardiac Arrest and Diagnosis of Probable Hypertrophic Cardiomyopathy. JACC Case Rep. 2026;31(12):107036. https://doi.org/10.1016/j.jaccas.2026.107036
34. Hsieh PN, Shen S, Chukwurah MI, et al. Athlete's Heart Revisited: Historical, Clinical, and Molecular Perspectives. Circ Res. 2025;137(2):231-254. https://doi.org/10.1161/CIRCRESAHA.125.325638
35. Finocchiaro G, Zorzi A, Abela M, et al. Abnormal electrocardiogram findings in athletes. Eur Heart J. 2026;47(2):152-169. https://doi.org/10.1093/eurheartj/ehaf646
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Katarzyna Jolanta Kuc, Patryk Jakubiak, Katarzyna Zegadło, Maciej Dobrucki, Krzysztof Brzezicki, Dominika Krakowiak , Kornelia Nieradka
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 46
Number of citations: 0
