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Risk of sudden cardiac death in athletes

Antonio Pelliccia, MD
Mark S Link, MD
Section Editors
Peter J Zimetbaum, MD
Scott Manaker, MD, PhD
Deputy Editor
Brian C Downey, MD, FACC


Sudden cardiac death (SCD) associated with athletic activity is a rare but devastating event. Victims are usually young and apparently healthy, but many have underlying cardiovascular disease that is not diagnosed until after the event. As a result, there is great interest in detecting such abnormalities early, and then defining appropriate activity restrictions for affected individuals to minimize the risk of SCD.

The majority of SCD events in athletes are due to malignant arrhythmias, usually sustained ventricular tachycardia (VT) degenerating into ventricular fibrillation (VF), or primary VF itself. In the small number of susceptible individuals with certain underlying cardiac disorders, athletics can increase the likelihood of these events in two ways: prolonged physical training induces changes in cardiac structure (eg, chamber dilation, myocyte death, and fibrosis) that create arrhythmic substrate; and, the immediate physiologic demands of intense athletics can trigger malignant arrhythmias and SCD.

The potential for SCD associated with athletic activity generates two questions:

How should individuals be evaluated prior to initiating athletic activity?

What restrictions should be placed upon individuals with known cardiovascular disease?


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Literature review current through: Sep 2016. | This topic last updated: Sep 24, 2015.
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