A recent BritishMedical Journal review of sudden cardiac death in athletes indicated that the prevalence of this tragic event is between one per 50,000 and 80,000 sports players per year. It’s without doubt a rare event, but one which demands front page public attention.
The most common cause is an underlying genetic condition such as hypertrophic cardiomyopathy. However, as was made clear in a Young Investigators Award study on Sunday, many SCDs in sport may be associated with a structurally normal heart at postmortem examination - and are referred to at autopsy as ‘unexplained’. This study, performed at St George’s London, was an analysis of 357 sudden deaths consecutively referred to a pathology centre between 1994 and 2014 in cases who were known to enjoy regular sport - 70% were competitive athletes.
The analysis showed that a normal heart was present in 56% of adolescents and children (<18 years), 44% of young adults (18-35 years) and 26% of older (>35 years) individuals. The presence of left ventricular fibrosis and arrhythmogenic right ventricular cardiomyopathy were more common in subjects who died during exercise.
The great debate in sports cardiology worldwide remains the implementation and extent of preparticipation screening for athletes, with the question resting on a balance of lives saved, athletes tested, psychological, ethical, and legal implications, and cost. Both the ESC and International Olympic Committee (IOC) ‘recommend’ and encourage cardiac screening for any young person taking part in competitive sport, but are keen to stress that sport itself does not lead to cardiac arrest. The IOC’s position, as clearly set out in its 2009 consensus statement, does not recommend as ‘compulsory’ periodic health examination for athletes and leaves that for sports authorities to decide. But it is, says David Zideman, a member of the IOC’s Medical and Scientific Games Group for Rio 2016, ‘a long and difficult argument’. His own position as an Olympic medic is to assume no-one has been screened.
Zideman reported at a Spotlight of the Congress Symposium on Saturday that none of the 10,508 athletes taking part in the London 2012 Olympics suffered a SCD or any cardiac event. There were requirements for emergency care on the field, but they were all injuries as a result of contact - and the one, the highest profile encounter, a clash of hockey stick and head. There were, however, two cardiac events among spectators at the London Olympics and Zideman emphasises that emergency services must plan for these events.
‘The number of athletes at any modern Olympics is relatively fixed,’ he told ESC Congress News, ‘so we are expecting a similar number in Rio and hopefully a similar profile for emergency care.’ And with the experience of London still close at hand, he has six lessons now ready for Rio: to plan carefully; to be appropriately equipped for any event (which includes prompt access to AEDs); to recruit extensively (there’ll be more than 3000 healthcare volunteers in Rio); to ensure that available skills match the circumstances; to train thoroughly; and to adapt to the location.
‘I’d like to see no illnesses or injuries in Rio,’ says Zideman, ‘but that’s not realistic at such a massive event. Hopefully, we’ll have a similar risk and outcome profile to London.’
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