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Screening to prevent sudden cardiac death in athletes

Mark S Link, MD
Antonio Pelliccia, MD
Section Editors
Peter J Zimetbaum, MD
Scott Manaker, MD, PhD
Francis G O'Connor, MD, MPH, FACSM
Deputy Editor
Brian C Downey, MD, FACC


Sudden cardiac death (SCD) associated with athletic activity is a rare but devastating event. Victims can be young and apparently healthy, and while many of these deaths are unexplained, a substantial number harbor underlying undiagnosed cardiovascular disease. As a result, there is great interest in early identification of at-risk individuals for whom appropriate activity restrictions can be implemented to minimize the risk of SCD.

The majority of SCD events in athletes are due to malignant arrhythmias, usually ventricular tachycardia (VT) or ventricular fibrillation (VF). In individuals with certain cardiac disorders (eg, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, etc), athletics may increase the likelihood of VT/VF in two ways:

Prolonged physical training may induce changes in cardiac structure (eg, interstitial fibrosis, disruption of normal myocardial architecture, dilation of right and left ventricle) in susceptible individuals that may create pathologic arrhythmogenic substrate.

The immediate physiologic demands of intense athletics (eg, hemodynamic overload, catecholamine release, electrolyte imbalance) may trigger malignant arrhythmias in susceptible individuals with underlying cardiac abnormalities.

As with screening for any condition, the primary purpose of screening athletes for cardiac pathology is to identify patients at higher risk of SCD whose prognosis could be improved with an intervention (in this case, activity restriction or modification, or other specific therapy targeted at the underlying pathology). The approach to screening athletes depends, in part, upon the age of the athlete along with the anticipated level of activity (ie, competitive versus recreational athletics).

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Literature review current through: Nov 2017. | This topic last updated: Oct 26, 2017.
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