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Cited by 555Cardiovascular Effects of ExerciseCardiomyopathy and Myosin StudiesCardiac electrophysiology and arrhythmias

Etiology of Sudden Death in Sports

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Finocchiaro, Gherardo, Papadakis, Michael, Robertus, Jan-Lukas, Dhutia, Harshil, Steriotis, Alexandros Klavdios, Tome, Maite, Mellor, Greg, Merghani, Ahmed +4 more·2016·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2016.02.062
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Abstract

Background Accurate knowledge of causes of sudden cardiac death (SCD) in athletes and its precipitating factors is necessary to establish preventative strategies. Objectives This study investigated causes of SCD and their association with intensive physical activity in a large cohort of athletes. Methods Between 1994 and 2014, 357 consecutive cases of athletes who died suddenly (mean 29 ± 11 years of age, 92% males, 76% Caucasian, 69% competitive) were referred to our cardiac pathology center. All subjects underwent detailed post-mortem evaluation, including histological analysis by an expert cardiac pathologist. Clinical information was obtained from referring coroners. Results Sudden arrhythmic death syndrome (SADS) was the most prevalent cause of death (n = 149 [42%]). Myocardial disease was detected in 40% of cases, including idiopathic left ventricular hypertrophy (LVH) and/or fibrosis (n = 59, 16%); arrhythmogenic right ventricular cardiomyopathy (ARVC) (13%); and hypertrophic cardiomyopathy (HCM) (6%). Coronary artery anomalies occurred in 5% of cases. SADS and coronary artery anomalies affected predominantly young athletes (≤ 35 years of age), whereas myocardial disease was more common in older individuals. SCD during intense exertion occurred in 61% of cases; ARVC and left ventricular fibrosis most strongly predicted SCD during exertion. Conclusions Conditions predisposing to SCD in sports demonstrate a significant age predilection. The strong association of ARVC and left ventricular fibrosis with exercise-induced SCD reinforces the need for early detection and abstinence from intense exercise. However, almost 40% of athletes die at rest, highlighting the need for complementary preventive strategies.

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  • Ventricular arrhythmia is believed to be the main mechanism of sudden cardiac death in athletes.

    “Ventricular arrhythmia is believed to be the main mechanism of SCD in athletes.3”

    From Ventricular Arrhythmia and Cardiac Fibrosis in Endurance Experienced Athletes (VENTOUX) (2025) · cites this paper as [3]

    The Causes section reports sudden arrhythmic death syndrome as the most common finding, accounting for 42% of athlete deaths. But the Study Population section defines that syndrome by a normal post-mortem examination, not a documented rhythm; the paper does not establish that ventricular arrhythmia is the main mechanism of SCD in athletes. (LLM, conf=0.79)

    Experimental — accuracy not yet measured

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Cites

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Research works printed but not linked: 27

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Authors
Finocchiaro, G., Papadakis, M., Robertus, J.-L., Dhutia, H., Steriotis, A. K., Tome, M., Mellor, G., Merghani, A., Malhotra, A., Behr, E., Sharma, S., & Sheppard, M. N.
Affiliations
  • St George's, University of London (GB)
  • University of London (GB)
Corresponding author
Sharma, Sanjay
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2016-05
Volume
67
Issue
18
Pages
2108-2115
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/j.jacc.2016.02.062
OpenAlex
W2347068500
Cited by
555
References
2
Citations by year
2026: 57 · 2025: 51 · 2024: 53 · 2023: 56 · 2022: 53 · 2021: 64 · 2020: 75 · 2019: 45 · 2018: 48 · 2017: 30 · 2016: 22 · 2015: 1
FWCI
33.15
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion, other-oa)
  • St George's Online Research Archive (St George's University of London) (acceptedVersion)
Funders
  • National Institute for Health and Care Research (CL-2011-16-501)
  • St. Jude Medical
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords
sudden cardiac death, athletes, sudden arrhythmic death, arrhythmogenic right ventricular cardiomyopathy, hypertrophic cardiomyopathy, left ventricular hypertrophy, left ventricular fibrosis, cardiomyopathy, coronary artery anomalies, sudden cardiac death prevention
MeSH terms
Adolescent, Adult, Arrhythmias, Cardiac, Cardiomyopathy, Hypertrophic, Coronary Vessel Anomalies, Death, Sudden, Physical Exertion, Female, Fibrosis, United Kingdom, Heart Ventricles, Humans, Male, Registries, Retrospective Studies, Hypertrophy, Left Ventricular, Arrhythmogenic Right Ventricular Dysplasia, Young Adult, Athletes

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