Abstract 20642: Why Arrhythmogenic Cardiomyopathy is Still a Major Cause of Sudden Death in Competitive Athletes Despite Preparticipation Screening?
Introduction: The incidence of sudden death (SD) in young competitive athletes has declined in Italy since the introduction of systematic screening including ECG. Mortality reduction was predominantly due to a lower incidence of SD from cardiomyopathies
Hypothesis: Arrhythmogenic cardiomyopathy (AC) should have also declined as a cause of SD in competitive athletes.
Results: During the study period 1981-2014, 75 competitive athletes died suddenly. Major causes at postmortem examination were AC, 27%; atherosclerotic coronary artery disease (CAD), 24%; congenital CAD, 16%; normal heart 10%; conduction system disease, 7%; hypertrophic cardiomyopathy, 5%; myocarditis, 4%; mitral valve prolapse, 3%. When analyzing the 26 AC cases, we subdivide those occurring before (group A, n.13 cases) and after 1998 (group B, n. 13 cases). In group A 11/13, 85% had typical AC, with inverted T wave in > V1-V2 and left bundle branch block (LBBB) ventricular arrhythmias (VA), but echocardiography was performed only once; and only 2 cases had left ventricular variant, not reaching the AC diagnostic criteria. All 13 cases of group B had left ventricular or biventricular variant of AC, with inverted T wave in V5-V6 (7/13, 54%), low QRS complex in 4 (4/13, 31%), LBBB or right bundle branch block VA (7/13, 54%). Echocardiography did not show morpho-functional abnormalities, while cardiac magnetic resonance (CMR) was performed only once with left ventricular late enhancement. At postmortem, all these AC cases demonstrated a subepicardial-midmural fibrofatty replacement of the left ventricular free wall, without thinning/aneurysm or dilatation.
Conclusions: AC still represents a major cause of SD in athletes in Italy since the left ventricular or biventricular variant without aneurysms escape routine echocardiographic detection. Athletes with inverted T waves in lateral leads and/or low QRS voltage as well as unexplained VA and normal echocardiography require further examination including CMR before allowing sport participation.
Author Disclosures: C. Basso: None. S. Rizzo: None. K. Pilichou: None. D. Corrado: None. G. Thiene: None.
- © 2014 by American Heart Association, Inc.