Sudden cardiac death in athletes: Outcomes in athletes with marked ECG repolarization abnormalities

This journal club looked at a paper related to sudden cardiac death in athletes. It’s a very topical subject at the moment, with the press reporting about cardiovascular events in the Boston marathon and the tragic death of a 30 year old lady at the London marathon.

Pelliccia A, Di Paolo FM, Quattrini FM, et al. Outcomes in athletes with marked ECG repolarization abnormalities. N Engl J Med 2008. 10: 152-61.

What was the aim of the paper?

It’s known that young athletes may have abnormal ECGs without evidence of cardiac disease. However, the question remains as to whether these abnormal ECG patterns represent the initial stage of cardiovascular disease, or are they just expressions of athletic conditioning? The researchers wanted to look at the long-term outcomes in athletes with ECGs characterised by abnormal repolarization.

What did the study involve?

This was a matched case-control study. The researchers reviewed ECG data from a database of 12,550 athletes evaluated at the Institute of Sports Medicine and Science in Italy. In Italy it is required by law for all athletes to undergo screening to rule out cardiovascular disease that could be associated with an increased risk during training and competition. The researchers identified 81 athletes that had abnormal ECGs (showing marked repolarization abnormalities) and excluded those that had evidence of structural heart disease. They compared this data with a control group of 229 athletes who had normal ECGs and no evidence of cardiovascular disease.

What were the main results?

Five of the 81 athletes with abnormal ECGs had a disease of the heart muscle called cardiomyopathy (one died suddenly at the age of 24 from undetected heart disease, three developed cardiomyopathy after an average of 12 years and one after 9 years of follow-up). None of the 229 control athletes had a cardiac event.

What can we take from it?

The researchers concluded that abnormal ECGs in apparently healthy athletes may show the initial expression of underlying heart disease that may be associated with adverse outcomes.

I really enjoyed reading this research paper and found it very informative. It addressed a very important topic and helped to add to what we already know about sudden cardiac death in athletes. The research question was well-developed, stating the population (young athletes), the parameter (abnormal ECGs) and the outcome (clinical outcomes). The study design was simple, with the researchers analysing data from a large number of athletes who were screened at the Institute of Sports Science and Medicine. We know that randomised controlled trials give the most robust evidence, however this was not ethically appropriate. The researchers didn’t state who analysed the ECGs but it was good to see that the control group were selected from the same database of athletes.

I’ve picked out the following comments about the research.

  • The article by Pelliccia and colleagues is a well written piece of work and identifies some ECG abnormalities that may contribute to sudden cardiac death in these athletes.
  • Is pre-screening really worth it if athletes continue to play on despite their awareness?!

Overall, this research shows that ECGs showing marked abnormalities can be useful for identifying those athletes who are at risk of subsequent development of heart disease. However, as Carla mentions in her comments, even if athletes knew that they were at risk of heart disease, would they give it all up to prevent such events?

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1 Comment

Filed under Sport Science Journal Club, Sudden cardiac death

One response to “Sudden cardiac death in athletes: Outcomes in athletes with marked ECG repolarization abnormalities

  1. Carla Gallagher

    Sudden cardiac arrest in athletes is becoming more and more prominent within sport and recent events are a tragic example of such incidents. Therefore the paper chosen this week hits on a topical subject and is hopefully of interest to most. The article by Pelliccia and colleagues is a well written piece of work and identifies some ECG abnormalities that may contribute to sudden cardiac death in these athletes. I felt the study design was appropriate for the research question and the methodology was performed stringently, however no hypothesis was stated by the authors.

    My main question arising from this paper is ‘Would athletes, if they knew the story, really give it all up in order to prevent such events?’ or ‘Is the here and now of years of training and elite status too much to give up?’ My answer would be that these athletes will still play on despite such risks and so would we all wouldn’t we?!

    In 2011 Stevenage Midfielder Mitchell Cole ended his time on an 8 year career due to a serious heart condition hypertrophic cardiomyopathy. However, Cole played with the condition for 9 years and risked his life every time he hit the pitch only giving up when training became more difficult and playing was taking its tole. So is pre-screening really worth it if athletes continue to play on despite their awareness?!

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