Sports-related sudden cardiac deaths in the young population of Switzerland.

In Switzerland, ECG screening was first recommended for national squad athletes in 1998. Since 2001 it has become mandatory in selected high-risk professional sports. Its impact on the rates of sports-related sudden cardiac death (SCD) is unknown. We aimed to study the incidence, causes and time trends of sports-related SCD in comparison to SCD unrelated to exercise in Switzerland. We reviewed all forensic reports of SCDs of the German-speaking region of Switzerland in the age group of 10 to 39 years, occurring between 1999 and 2010. Cases were classified into three categories based on whether or not deaths were associated with sports: no sports (NONE), recreational sports (REC), and competitive sports (COMP). Over the 12-year study period, 349 SCD cases were recorded (mean age 30±7 years, 76.5% male); 297 cases were categorized as NONE, 31 as REC, and 21 as COMP. Incidences of SCD per 100,000 person-years [mean (95% CI)] were the lowest in REC [0.43 (0.35-0.56)], followed by COMP [1.19 (0.89-1.60)] and NONE [2.46 (2.27-2.66)]. In all three categories, coronary artery disease (CAD) with or without acute myocardial infarction (MI) was the most common cause of SCD. Three professional athletes were identified in COMP category which all had SCD due to acute MI. There were no time trends, neither in overall, nor in cause-specific incidences of SCD. The incidence of SCD in young individuals in Switzerland is low, both related and unrelated to sports. In regions, like Switzerland, where CAD is the leading cause of SCD associated with competitions, screening for cardiovascular risk factors in addition to the current PPS recommendations might be indicated to improve detection of silent CAD and further decrease the incidence of SCD

Prevalence of abnormal electrocardiograms in Swiss elite athletes detected with modern screening criteria.

Sudden cardiac arrest in athletes is a rare but dramatic event. The value of a routine electrocardiogram (ECG) during preparticipation screening (PPS) remains controversial, partly because of the relatively high number of false positive findings. Our study aimed to evaluate the prevalence of abnormal ECGs in consecutive Swiss elite athletes, overall and with regard to different sports classes, using modern screening criteria. We analysed the 12-lead resting ECGs of high-level elite athletes (age ≥14 years) recorded at the Swiss Olympic Medical Centre Magglingen between 2013 and 2016 during routine PPS. The overall prevalence of abnormal ECGs was evaluated and compared in accordance with the original and revised Seattle criteria. Sports disciplines were categorised according to their static (estimated percentage of maximal voluntary contraction, I-III) and dynamic (estimated percentage of maximal oxygen uptake, A-C) components, and the prevalence of abnormal ECGs compared between sports classes by Fisher's exact test (with alpha set at 0.05). ECGs from 287 consecutive athletes were analysed (64.1% male; 99.7% Caucasian; median age 20.4 ± 4.9 years; median weekly training volume 17.7 ± 7.1 hours). Based on original Seattle criteria, eight (2.8%) ECGs were classified as abnormal: three T-wave inversion (TWI), one Q-wave duration >40 ms, two QRS left axis deviation, two Q-wave amplitude >3 mm. The use of the revised Seattle criteria reduced the number of abnormal ECGs to four (1.4%): three TWI, one Q-wave duration >40 ms. Further cardiological work-up revealed an underlying structural heart disease in only one of these four athletes (inferolateral TWI on ECG), consisting of very localised mid-wall fibrosis suggestive of former myocarditis. There was a significant difference in occurrence of abnormal ECGs between the different sports categories (p = 0.018). All four abnormal ECGs according to the revised Seattle criteria occurred in the high dynamic sport classes (IIC and IIIC); three out of the four were found in the high dynamic high static class (IIIC). In our cohort of high-level elite athletes, the prevalence of abnormal ECGs according to modern screening criteria was very low. All athletes with an abnormal ECG performed high dynamic sports. Less than one percent of our athletes had a new relevant cardiac diagnosis

Sports-related sudden cardiac death in Switzerland classified by static and dynamic components of exercise.

BACKGROUND: Sports-related sudden cardiac deaths (SrSCDs) occur most frequently in highly dynamic and/or static sports. We aimed to assess the incidence and characteristics of SrSCDs in Switzerland and to compare SrSCD occurrence according to sports categories with the sports participation behaviour in the general population. METHODS: Between 1999 and 2010, forensic reports of SrSCDs in young individuals (10-39 years of age) were retrospectively reviewed and categorised based on peak static (increasing from I to III) and dynamic sports components (increasing from A to C). Data were compared to the sports participation behaviour of the Swiss population. RESULTS: Sixty-nine SrSCDs were identified. Forty-eight (69.6%) occurred during recreational sports (REC) and 21 (30.4%) during competitive sports (COMP). Incidences (per 100,000 athlete person-years) for COMP and REC were 0.90 and 0.52, respectively (p = 0.001). Most SrSCDs occurred in IC (23 cases, 33.3%), followed by IIC (13, 18.9%), IIIA and IIIC (11 each, 15.9%), IIIB (6, 8.7%), IIA (4, 5.8%) and IB sports categories (1, 1.5%). No SrSCDs were found in IA and IIB sports categories. Incidences between sports categories (IIIA 0.25, IB 0.25, IC 0.18, IIC 0.33 and IIIC 0.25) were not significantly different except to IIA (0.94, p < 0.001), due to the fact that few people were involved in this sports category. Coronary artery disease (CAD) was the most common underlying pathology of SrSCD. CONCLUSIONS: In this Swiss cohort, incidence of SrSCD was very low and similar in all sports categories classified by their static and dynamic components. However, the incidence was higher in COMP compared to REC, and CAD proved to be the most common underlying cause of SrSCD