Sudden death in competitive athletes

Sudden death in athletes is an extremely rare event yet no less tragic for its infrequency. Up to 90% of these deaths are due to underlying cardiovascular diseases and therefore categorized as sudden cardiac death (SCD). The causes of SCD among athletes are strongly correlated with age. In young athletes (<35 years), the leading causes are congenital cardiac diseases, particularly hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, and congenital coronary artery anomalies. By contrast, most of deaths in older athletes (G35 years) are due to coronary artery disease. This review focuses on the cardiac causes of SCD and provides a brief summary of the principal noncardiac causes. Current preparticipation screening strategies are also discussed, with particular emphasis on the Italian experience.