title: Etiology of Sudden Death in Sports: Insights From a United Kingdom Regional Registry.
abstract: Accurate knowledge of causes of sudden cardiac death (SCD) in athletes and its precipitating factors is necessary to establish preventative strategies.
  
  
  
  This study investigated causes of SCD and their association with intensive physical activity in a large cohort of athletes.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Cardiovascular Sciences Research Centre, St. George's, University of London, London, United Kingdom.
authors.forename: Gherardo
authors.initials: G
authors.lastname: Finocchiaro
authors.affiliation: Cardiovascular Sciences Research Centre, St. George's, University of London, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Papadakis
authors.affiliation: Cardiovascular Pathology Department, St. George's, University of London, London, United Kingdom.
authors.forename: Jan-Lukas
authors.initials: JL
authors.lastname: Robertus
authors.affiliation: Cardiovascular Sciences Research Centre, St. George's, University of London, London, United Kingdom.
authors.forename: Harshil
authors.initials: H
authors.lastname: Dhutia
authors.affiliation: Cardiovascular Sciences Research Centre, St. George's, University of London, London, United Kingdom.
authors.forename: Alexandros Klavdios
authors.initials: AK
authors.lastname: Steriotis
authors.affiliation: Cardiovascular Sciences Research Centre, St. George's, University of London, London, United Kingdom.
authors.forename: Maite
authors.initials: M
authors.lastname: Tome
authors.affiliation: Cardiovascular Sciences Research Centre, St. George's, University of London, London, United Kingdom.
authors.forename: Greg
authors.initials: G
authors.lastname: Mellor
authors.affiliation: Cardiovascular Sciences Research Centre, St. George's, University of London, London, United Kingdom.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Merghani
authors.affiliation: Cardiovascular Sciences Research Centre, St. George's, University of London, London, United Kingdom.
authors.forename: Aneil
authors.initials: A
authors.lastname: Malhotra
authors.affiliation: Cardiovascular Sciences Research Centre, St. George's, University of London, London, United Kingdom.
authors.forename: Elijah
authors.initials: E
authors.lastname: Behr
authors.affiliation: Cardiovascular Sciences Research Centre, St. George's, University of London, London, United Kingdom. Electronic address: sasharma@sgul.ac.uk.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Cardiovascular Pathology Department, St. George's, University of London, London, United Kingdom.
authors.forename: Mary N
authors.initials: MN
authors.lastname: Sheppard
mesh_terms: D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000401:mortality; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000401:mortality; D056352:Athletes; D002312:Cardiomyopathy, Hypertrophic / Q000401:mortality; D003330:Coronary Vessel Anomalies / Q000401:mortality / Q000473:pathology; D003645:Death, Sudden / Q000209:etiology*; D005260:Female; D005355:Fibrosis; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000401:mortality; D008297:Male; D005082:Physical Exertion; D012042:Registries; D012189:Retrospective Studies; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: arrhythmogenic right ventricular cardiomyopathy; athletes; sudden death