Article

Sudden cardiac death of a young athlete is the most tragic event in sports and
devastates the family, the sports medicine team, and the local community. Such a
fatality represents the first manifestation of cardiac disease in up to 80% of
young athletes who remain asymptomatic before sudden cardiac arrest occurs; this
explains the limited power of screening modalities based solely on history and
physical examination. The long-running Italian experience showed that
electrocardiogram (ECG) screening definitively improves the sensitivity of
pre-participation evaluation for heart diseases and substantially reduces the
risk of death in the athletic field (primary prevention). However, some cardiac
conditions, such as coronary artery diseases, present no abnormalities on 12-lead
ECG. Moreover, cardiac arrest due to non-penetrating chest injury (commotio
cordis) cannot be prevented by screening. This justifies the efforts for
implementing programmes of early external defibrillation of unpredictable
arrhythmic cardiac arrest. This article reviews the epidemiology of sudden
cardiac arrest in the athlete in terms of incidence, sport-related risk,
underlying causes, and the currently available prevention programmes such as
pre-participation screening and early external defibrillation by using automated
external defibrillators. The best strategy is to combine synergistically primary
prevention of sudden cardiac death by pre-participation identification of
athletes affected by at-risk cardiomyopathies and secondary prevention with
back-up defibrillation of unpredictable sudden cardiac arrest on the athletic
field.

Langue : ANGLAIS