Table 1.
Details of Sudden Cardiac Arrest among Competitive Athletes.*
| Patient No. (Sex, Age) |
Bystander Witnessed; Performed CPR |
EMS Response Time |
Initial Cardiac Rhythm |
No. of Shocks |
Outcome | Autopsy | Molecular Autopsy |
Cause of Sudden Cardiac Arrest |
Basis of Diagnosis† |
Previous Cardiac Tests |
Follow-up |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 (M, 44 yr) | No; No | ND | VF/VT | 1 | Admitted to hospital; survived | NA | NA | Ischemic | Angiogram | ECG and echocardiogram normal | PCI and stents placed for coronary artery disease |
| 2 (M, 30 yr) | Yes; Yes | ND | VF/VT | 1 | Admitted to hospital; survived | NA | NA | Primary arrhythmic | — | None | ECG, angiogram, stress test, and MRI normal; ICD implanted |
| 3 (M, 16 yr) | Yes; Yes | 6.5 min | VF/VT | 2 | Admitted to hospital; survived | NA | NA | Commotio cordis | History | None | In long-term care facility owing to anoxic brain injury |
| 4 (F, 22 yr) | Yes; No | ND | PEA | 0 | Admitted to hospital; survived | NA | NA | Primary arrhythmic | — | None | ECG and echocardiogram normal; MRI showed possible myocarditis; ICD implanted |
| 5 (M, 25 yr) | Yes; Yes | 8.0 min | VF/VT | 2 | Admitted to hospital; survived | NA | NA | Primary arrhythmic | — | None | ECG, echocardiogram, and angiogram normal; ICD implanted |
| 6 (M, 23 yr) | Yes; Yes | 7.9 min | VF/VT | 0 | Admitted to hospital; survived | NA | NA | Primary arrhythmic | — | None | ECG abnormal ‡; echocardiogram and MRI normal |
| 7 (M, 13 yr) | Yes; Yes | 5.4 min | VF/VT | 0 | Admitted to hospital; survived | NA | NA | Commotio cordis | History | None | ECG, echocardiogram, and stress test normal; incidental anomalous coronaries |
| 8 (M, 35 yr) | Yes; Yes | 9.5 min | VF/VT | 1 | Died in ED | Yes | NA | Ischemic | Autopsy | None | NA |
| 9 (M, 18 yr) | Yes; Yes | 11.0 min | Not shockable | 3 | Died in ED | Yes | No mutations detected | Primary arrhythmic | Normal autopsy | None | NA |
| 10 (M, 27 yr) | Yes; No | 4.8 min | Asystole | 0 | Died in ED | Yes | No mutations detected | Primary arrhythmic | Normal autopsy | None | NA |
| 11 (M, 20 yr) | Yes; Yes | 9.1 min | VF/VT | 5 | Died in ED | Yes | NA | Anomalous coronaries | Autopsy | Unknown | NA |
| 12 (M, 15 yr) | Yes; No | 5.2 min | VF/VT | 5 | Died in ED | Yes | Mutation (variant) of unknown significance§ | Hypertrophic cardiomyopathy | Autopsy | ECG and echocardiogram normal | NA |
| 13 (F, 18 yr) | Yes; Yes | 7.0 min | PEA | 0 | Died in ED | Yes | NA | Anomalous coronaries | Autopsy | None | NA |
| 14 (M, 39 yr) | Yes; Yes | ND | VF/VT | 1 | Died in ED | Yes | NA | Ischemic | Autopsy | None | NA |
| 15 (M, 18 yr) | Yes; No | 5.3 min | VF/VT | 5 | Admitted to hospital; died | No¶ | NA | Hypertrophic cardiomyopathy | In-hospital testing | None | NA |
| 16 (F, 12 yr) | Yes; Yes | ND | Not documented | 0 | Died in ED | Yes | NA | Anomalous coronaries | Autopsy | Previous investigations normal; cleared for competition | NA |
The specific type of sports activity in which each patient was participating is not specified to preserve patient confidentiality. CPR denotes cardiopulmonary resuscitation, ECG electrocardiogram, ED emergency department, EMS emergency medical services, ICD implantable cardioverter–defibrillator, MRI magnetic resonance imaging, NA not applicable, ND not documented, PCI percutaneous coronary intervention, PEA pulseless electrical activity, VF ventricular fibrillation, and VT ventricular tachycardia.
A dash indicates no diagnosis.
The patient had an abnormal electrocardiogram, with diffuse T wave inversions, but hypertrophic cardiomyopathy and long-QT syndrome were ruled out after expert consultation.
The mutation detected was TNNI3 Arg141Gln.
In-hospital investigations confirmed the diagnosis; therefore, an autopsy was deemed unnecessary.