Sudden Cardiac Arrest during Participation in Competitive Sports
Open accessAbstract
BACKGROUND: The incidence of sudden cardiac arrest during participation in sports activities remains unknown. Preparticipation screening programs aimed at preventing sudden cardiac arrest during sports activities are thought to be able to identify at-risk athletes; however, the efficacy of these programs remains controversial. We sought to identify all sudden cardiac arrests that occurred during participation in sports activities within a specific region of Canada and to determine their causes. METHODS: In this retrospective study, we 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 noncardiac 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. RESULTS: 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. CONCLUSIONS: In our study involving persons who had out-of-hospital cardiac arrest, the incidence of sudden cardiac arrest during participation in competitive sports was 0.76 cases per 100,000 athlete-years. The occurrence of sudden cardiac arrest due to structural heart disease was uncommon during participation in competitive sports. (Funded by the National Heart, Lung, and Blood Institute and others.).
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Male athletes are over seven times more likely to suffer sudden cardiac death than female athletes.
“We also only recruited male athletes, who are over seven times more likely to suffer SCD than female athletes.17”
From Ventricular Arrhythmia and Cardiac Fibrosis in Endurance Experienced Athletes (VENTOUX) (2025) · cites this paper as [17]
The Results report an overall sudden cardiac arrest incidence among competitive athletes, and the Discussion distinguishes cardiac arrest from cardiac death. Neither section gives a male-to-female risk comparison; searches for male, female, and a sevenfold difference found no passage supporting the claimed ratio. (LLM, conf=0.74)
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Myocardial Inflammation, Sports Practice, and Sudden Cardiac Death: 2021 Update
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Exercise in hypertrophic cardiomyopathy: restrict or rethink
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Self-citationA 10-year review of sudden death during sporting activities
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Association Between Silent Myocardial Infarction and Long‐Term Risk of Sudden Cardiac Death
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Cardiac structure and function in response to a multi-stage marathon over 4486 km
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Pre-participation screening of asymptomatic athletes
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Ventricular Arrhythmia and Cardiac Fibrosis in Endurance Experienced Athletes (VENTOUX)
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“17”
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Michelland, L., Murad, M. H., Bougouin, W., Broek, M. V. D., Prokop, L. J., Anys, S., Perier, M., Cariou, A., Empana, J. P., Marijon, É., et al. (2022) · European Heart Journal · doi:10.1093/eurheartj/ehac586 · Cited by 20 · see citing works
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Cardiac evaluation of young athletes: Time for a risk‐based approach?
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Sports activity and paediatric out-of-hospital cardiac arrest at schools in Japan
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Atrial fibrillation and risk of sudden cardiac arrest in young adults
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Symptoms Preceding Sports-Related Sudden Cardiac Death in Persons Aged 1–49 Years
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Adaptive Recognition of Motion Posture in Sports Video Based on Evolution Equation
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Sudden Cardiac Arrest in Athletes
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Cardiopulmonary Resuscitation and Defibrillator Use in Sports
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Outcomes of Cardiac Screening in Adolescent Soccer Players
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Recommendations for exercise and screening for safe athletic participation in hypertensive youth
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RetractedCardiac Arrest during Competitive Sports
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Self-citationA Narrative Review on Exercise and Cardiovascular Events: “Primum Non Nocere”
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Myocardial Infarction in Young Athletes
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All-cause mortality risks among participants in mass-participation sporting events
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International Criteria for Reporting Study Quality for Sudden Cardiac Arrest/Death Tool
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Epidemiology of Pediatric Cardiac Arrest
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Sudden Cardiac Arrest in Athletes: A Primary Level of Prevention
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Undetected coronary artery disease in apparently healthy athletes
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Out-of-Hospital Cardiac Arrests during Mass-Participation Endurance Events: A Case Series
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Cardiac Events in World-Class Athletes: An Internet-Based Study
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Self-citationSports-Related Sudden Cardiac Deaths in Singapore – An Eleven-Year Review
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- Authors
- Landry, C. H., Allan, K. S., Connelly, K. A., Cunningham, K., Morrison, L. J., & Dorian, P.
- Affiliations
- St. Michael's Hospital (CA)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2017-11-16
- Volume
- 377
- Issue
- 20
- Pages
- 1943-1953
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC5726886
- OpenAlex
- W2768869854
- Cited by
- 192
- References
- 34
- Citations by year
- 2026: 7 · 2025: 14 · 2024: 17 · 2023: 22 · 2022: 21 · 2021: 27 · 2020: 26 · 2019: 23 · 2018: 34 · 2017: 1
- FWCI
- 17.78
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5u01hl077863-11)
- National Heart, Lung, and Blood Institute (U01-HL077863, U01HL077872)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Keywords
- sudden cardiac arrest, competitive sports, athletes, pre-participation screening, incidence, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, out-of-hospital cardiac arrest, structural heart disease
- MeSH terms
- Adolescent, Adult, Cause of Death, Child, Female, Heart Diseases, Humans, Male, Middle Aged, Ontario, Retrospective Studies, Sports, Survival Rate, Databases, Factual, Death, Sudden, Cardiac, Young Adult, Athletes, Out-of-Hospital Cardiac Arrest
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