November 23, 2017 – We all have heard of it: While in full action of the game, a young soccer player collapsed on the field and died. Same for a seemingly healthy and very competitive marathon runner. A shocking and nightmarish experience in sports. Diagnosis: Sudden cardiac arrest.
The question arises if such cases could be prevented? Did the victims have predispositions which would have been recognizable had they undergone undergone some kind of screening for risk factors bevor entering competitive sportive activity? And, of course, how frequent do such cases occur (i.e., how frequent would you find athletes who carry possibly deadly predispositions, if any)?
A recent study by a Canadian research team has addressed some of this questions. In their retrospective study, the team used the Rescu Epistry cardiac arrest database (which contains records of every cardiac arrest attended by paramedics in the network region) to identify all out-of-hospital cardiac arrests that occurred from 2009 through 2014 in persons 12 to 45 years of age during participation in a sport. Cases were adjudicated as sudden cardiac arrest (i.e., having a cardiac cause) or as an event resulting from a non-cardiac cause, on the basis of records from multiple sources, including ambulance call reports, autopsy reports, in-hospital data, and records of direct interviews with patients or family members.
They found that over the course of 18.5 million person-years of observation, 74 sudden cardiac arrests occurred during participation in a sport; of these, 16 occurred during competitive sports and 58 occurred during noncompetitive sports. The incidence of sudden cardiac arrest during competitive sports was 0.76 cases per 100,000 athlete-years, with 43.8% of the athletes surviving until they were discharged from the hospital. Among the competitive athletes, two deaths were attributed to hypertrophic cardiomyopathy and none to arrhythmogenic right ventricular cardiomyopathy. Three cases of sudden cardiac arrest that occurred during participation in competitive sports were determined to have been potentially identifiable if the athletes had undergone preparticipation screening.
Previously, researchers had identified a new gene that can lead to sudden death among young people and athletes. The gene, called CDH2, causes arrhythmogenic right ventricle cardiomyopathy (ARVC), which is a genetic disorder that predisposes patients to cardiac arrest and is a major cause of unexpected death in seemingly healthy young people (Thasso Post had an article on the subject). Whether the tree cases in the present study which could potentially have been identified through prospective pre-competition screening were carriers of that risk gene (i.e., CDH2) is unfortunately not clear.
Although statistically seen very rare, cases of spontaneous deadly incidences are real and occur from all sports. It seems that often soccer players are affected. See the following video, and be aware that there are may more victims who remain anonymous and should also not be forgotten.