Arrhythmias & electrophysiology
Sudden Death in Young Competitive Athletes Due to Arrhythmogenic Cardiomyopathy: A 4-Decade National Referral Center Experience
Authors' conclusion
ACM-related SCD incidence appeared lower in the post-2010 period. A phenotypic shift toward the left ventricular variant is observed, with ECG changes in a minority of cases and usually normal 2-dimensional echocardiography. If the index of suspicion is high, contrast-enhanced cardiac magnetic resonance is crucial for early identification and SCD prevention.
Study context
- Population
- Competitive athletes (≤40 years old) dying suddenly due to arrhythmogenic cardiomyopathy, North-East Italy registry of juvenile sudden cardiac death (SCD), including cases referred from other regionsathletes with arrhythmogenic cardiomyopathy (ACM) enrolled (50 men, 25±6.4 years)
- Participants
- Fifty-one athletes
- Exposure
- before and after 2010
Methodological detailsnational referral center, 1985 to 2024
- National referral center
- 1985 to 2024
Main finding
As reported in the abstract
ACM was the cause of SCD in athletes
29%
Observational data: associations, not effects.
Further findings
Twelve-lead ECG abnormalities
- Twelve-lead ECG abnormalities — overall
- 50.9%
- Twelve-lead ECG abnormalities — negative T waves
- 39.2%
- Twelve-lead ECG abnormalities — low QRS voltage
- 25.5%
- Incidence rate of SCD in athletes: before 2010 0.43 (interval 0.27–0.65) per 100 000/y
- Incidence rate of SCD in athletes: after 2010 0.14 (interval 0.05–0.33) per 100 000/y
Pattern of ACM
- Right ventricular/biventricular
- 74.5%
- Left ventricular
- 25.5%
- Left ventricular after 2010
- 41%
Fibrofatty replacement
- Transmural in right ventricular/biventricular ACM
- 63%
- Exclusively subepicardial-midmural in left ventricular ACM
Abnormalities at first-line preparticipation screening
- Overall
- 62.7%
- Before 1994
- 83.3%
- After 2010
- 40.9%
Premature ventricular complexes/nonsustained ventricular tachycardia with left bundle-branch block or multiple morphologies on basal or limited exercise ECG
- Present
- 35.3%
Positive tests
- Maximal stress test
- 55%
- Holter
- 45.4%
- 2-dimensional echocardiography
- 5.8%
Late gadolinium enhancement on contrast-enhanced cardiac magnetic resonance
- Detected in the only case who underwent contrast-enhanced cardiac magnetic resonance
Original publication
Summarised from the published abstract; every number is checked against it