Sudden Cardiac Death in Athletes: Risk Factors, Screening and Prevention
DOI:
https://doi.org/10.12775/QS.2026.73.75617Keywords
sudden cardiac death, sudden cardiac arrest, athletes, cardiovascular screening, electrocardiography, cardiopulmonary resuscitationAbstract
Background: Sudden cardiac death (SCD) in athletes is rare, but it remains an important problem because it may occur unexpectedly in individuals with no previously recognized cardiovascular disease. Its causes differ with age and include cardiomyopathies, coronary artery abnormalities, myocarditis, coronary artery disease and primary electrical disorders.
Aim: To summarize current evidence on the epidemiology, causes, risk factors and warning signs of SCD in athletes, and to discuss cardiovascular screening, prevention, emergency management and return to sport.
Materials and methods: A narrative review was conducted using PubMed, Web of Science and Google Scholar. English-language full-text studies published between 2015 and 2026 were considered, including original studies, systematic reviews, meta-analyses and narrative reviews.
Results: SCD is uncommon, but its incidence varies between athlete populations and is higher in males. In younger athletes, cardiomyopathies, coronary artery anomalies and primary electrical disorders are important causes, while coronary artery disease becomes more relevant with age. ECG screening may improve the detection of cardiovascular conditions associated with SCD, although its effect on mortality remains uncertain. Early CPR and rapid AED use are consistently associated with better survival after sports-related cardiac arrest.
Conclusions: Prevention should combine cardiovascular assessment with awareness of warning symptoms and effective emergency preparedness. Return-to-sport decisions should be individualized according to the underlying cardiovascular condition and follow-up findings.
References
1. Hajduczok AG, Ruge M, Emery MS. Risk factors for sudden death in athletes, is there a role for screening? Curr Cardiovasc Risk Rep. 2022;16(10):97-109. https://doi.org/10.1007/s12170-022-00697-9
2. Dores H, Dinis P, Viegas JM, Freitas A. Preparticipation cardiovascular screening of athletes: current controversies and challenges for the future. Diagnostics (Basel). 2024;14(21):2445. https://doi.org/10.3390/diagnostics14212445
3. Dhutia H, MacLachlan H. Cardiac screening of young athletes: a practical approach to sudden cardiac death prevention. Curr Treat Options Cardiovasc Med. 2018;20(10):85. https://doi.org/10.1007/s11936-018-0681-4
4. 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
5. Drezner JA, Peterson DF, Siebert DM, Cox Thomas L, Lopez-Anderson M, Suchsland MZ, 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
6. Bohm P, Meyer T, Narayanan K, Schindler M, Weizman O, Beganton F, et al. Sports-related sudden cardiac arrest in young adults. Europace. 2023;25(2):627-633. https://doi.org/10.1093/europace/euac172
7. Han J, Lalario A, Merro E, Sinagra G, Sharma S, Papadakis M, et al. Sudden cardiac death in athletes: facts and fallacies. J Cardiovasc Dev Dis. 2023;10(2):68. https://doi.org/10.3390/jcdd10020068
8. Harmon KG, Asif IM, Maleszewski JJ, Owens DS, Prutkin JM, Salerno JC, et al. Incidence, cause, and comparative frequency of sudden cardiac death in National Collegiate Athletic Association athletes: a decade in review. Circulation. 2015;132(1):10-19. https://doi.org/10.1161/CIRCULATIONAHA.115.015431
9. Peterson DF, Kucera K, Cox Thomas L, Maleszewski J, Siebert D, Lopez-Anderson M, 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
10. Kim JH, Rim AJ, Miller JT, Jackson M, Patel N, Rajesh S, et al. Cardiac arrest during long-distance running races. JAMA. 2025;333(19):1699-1707. https://doi.org/10.1001/jama.2025.3026
11. De Gaspari M, Pilichou K, Zorzi A, Bueno Marinas M, Cason M, Celeghin R, et al. Sudden death in young competitive athletes due to arrhythmogenic cardiomyopathy: a 4-decade national referral center experience. Circ Arrhythm Electrophysiol. 2026;19(7):e014877. https://doi.org/10.1161/CIRCEP.125.014877
12. Waite O, Smith A, Madge L, Spring H, Noret N. Sudden cardiac death in marathons: a systematic review. Phys Sportsmed. 2016;44(1):79-84. https://doi.org/10.1080/00913847.2016.1135036
13. Michelland L, Murad MH, Bougouin W, Van Der Broek M, Prokop LJ, Anys S, et al. Association between basic life support and survival in sports-related sudden cardiac arrest: a meta-analysis. Eur Heart J. 2023;44(3):180-192. https://doi.org/10.1093/eurheartj/ehac586
14. 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
15. 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
16. Hansen CJ, Svane J, Palsøe MK, Isbister JC, Paratz E, Molina P, et al. Toxicology screening in sports-related sudden cardiac death: a multinational observational study. JACC Clin Electrophysiol. 2024;10(3):515-523. https://doi.org/10.1016/j.jacep.2023.11.006
17. Goff NK, Hutchinson A, Koek W, Kamat D. Meta-analysis on the effectiveness of ECG screening for conditions related to sudden cardiac death in young athletes. Clin Pediatr (Phila). 2023;62(10):1158-1168. https://doi.org/10.1177/00099228231152857
18. Lear A, Patel N, Mullen C, Simonson M, Leone V, Koshiaris C, et al. Screening electrocardiogram in young athletes and military members: a systematic review and meta-analysis. J Athl Train. 2022;57(5):444-451. https://doi.org/10.4085/1062-6050-0746.20
19. Albiński M, Saubade M, Menafoglio A, Meyer P, Capelli B, Perrin T, et al. Diagnostic yield and cost analysis of electrocardiographic screening in Swiss paediatric athletes. J Sci Med Sport. 2022;25(4):281-286. https://doi.org/10.1016/j.jsams.2021.11.039
20. Compagnucci P, Volpato G, Falanga U, Cipolletta L, Conti MA, Grifoni G, et al. Myocardial inflammation, sports practice, and sudden cardiac death: 2021 update. Medicina (Kaunas). 2021;57(3):277. https://doi.org/10.3390/medicina57030277
21. Tso J, Turner CG, Kim JH. A hidden threat: anomalous aortic origins of the coronary arteries in athletes. Curr Treat Options Cardiovasc Med. 2020;22(12):67. https://doi.org/10.1007/s11936-020-00859-1
22. Romagnoli S, Ripanti F, Morettini M, Burattini L, Sbrollini A. Wearable and portable devices for acquisition of cardiac signals while practicing sport: a scoping review. Sensors (Basel). 2023;23(6):3350. https://doi.org/10.3390/s23063350
23. Arzayus-Patiño L, Carabali-Bonilla YF, Mora-Salazar MC, Castro Gómez C, Benavides-Cordoba V. Cardiovascular diseases and risk factors associated with sudden cardiac death in amateur athletes: a scoping review. Front Public Health. 2026;14:1770168. https://doi.org/10.3389/fpubh.2026.1770168
24. Caramoci A, Smaranda AM, Drăgoiu TS, Bădărău IA. ECG screening in athletes: a systematic review of sport, age, and gender variations. Rev Cardiovasc Med. 2025;26(5):38209. https://doi.org/10.31083/RCM38209
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Copyright (c) 2026 Jarosław Dudek, Jakub Gałwiaczek, Damian Grębosz, Krzysztof Lis, Aleksandra Kinga Łysak, Aleksandra Kalisz, Łucja Ilkiewicz
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