Cardiac Arrest and Sudden Death in Competitive Athletes with Arrhythmogenic Right Ventricular Dysplasia

Abstract

Arrhythmogenic right ventricular dysplasia (ARVD) is a predisposing factor for sport-related cardiac arrest (CA), sudden cardiac death (SD), and life-threatening ventricular tachyarrhythmias (VT). The aim of this study was the assessment of athletes with ARVD, particularly the CA survivors. From 1974 to January 1996, 1642 competitive athletes (aver. 25.5 yr.), 136 of whom were top level athletes (TLA), were studied for important arrhythmic manifestations. All athletes underwent an individualised study protocol including a series of non invasive and invasive diagnostic techniques. One hundred and one athletes (90 males, 11 females, aver. 25.9 yr.) were diagnosed as being affected by ARVD on the basis of the WHO/ISFC criteria. The same percentage (about 6%) of ARVD is present in both the general arrhythmic athletes population and in the subgroup of TLA. Prevalence of ARVD among athletes with CA or SD is high (respectively 23% and 25%), confirming the observation that ARVD is one of the major causes of SD in Italian athletes. All CA were athletic activity related, indicating the potentiality of exercise as a cause of electrical destabilisation in subjects with ARVD. In athletes with documented ARVD intense sport activity has to be proscribed. In athletes at risk of CA or SD an aggressive treatment, ICD implantation and RF catheter ablation must be taken into consideration.

Arrhythmogenic right ventricular dysplasia/ cardiomyopathy

“…First, it is recommended that all patients with ARVD/C avoid competitive athletics. Activities such as golf or walking are encouraged, whereas activities such as marathon running or weight lifting should be strongly discouraged because they may hasten the progression of the disease [34].…”

Task Force on Sudden Cardiac Death of the European Society of Cardiology

“…Strenuous exercise, sport and acute mental stress are major triggering factors (23-100%) of SCD in patients with RVC [324][325][326][327] . Patients with RVC should therefore be strongly discouraged from practicing competitive sports.…”

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

“…SCD occurs relatively frequently during exercise or during stress, but SCD with no apparent provocation is not uncommon (732). In one Italian series, up to 25% of SCD in athletes was related to ARVC (733). Although SCD usually occurs in individuals with grossly visible RV abnormalities, it can occur in those with only microscopic abnormalities and no obvious RV enlargement (734).…”