scholarly journals Screening electrocardiogram in young athletes and military members: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Aaron Lear ◽  
Niraj Patel ◽  
Chanda Mullen ◽  
Marian Simonson ◽  
Vince Leone ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Meta Analysis ◽  
Sudden Cardiac Arrest ◽  
Risk Of Bias ◽  
Young Athletes ◽  
Data Synthesis ◽  
Conference Abstract ◽  
Military Members

AbstractObjectiveTo determine the effect of electrocardiogram (ECG) screening on prevention of sudden cardiac arrest and death (SCA/D) in young athletes and military members.Data SourcesMEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORT discus, PEDro, and clinicaltrials.gov were searched from inception to dates between 2/21/19 and 7/29/19.Study SelectionRandomized and non-randomized controlled trials, where pre-participation examination including ECG was the primary intervention used to screen athletes or military 40 years of age or younger. Accepted controls were no screening, usual care, or pre-participation examination without ECG. 3 published studies, and one conference abstract were identified for inclusion.Data ExtractionIn all four studies, risk of bias was assessed with the Cochrane risk of bias tool, and found to be generally high. Two studies had data extracted for random effects meta-analysis, and the remaining study and conference abstract were included in narrative review.Data Synthesis4 studies (11,689,172 participants) were included, all at high risk of bias. Pooled data from two studies (n= 3,869,274; very low quality) showed a 42% relative decrease in sudden cardiac death, equating to an absolute risk reduction of .0016%. Uncertainty was high, with a potential 67% relative decrease to a 45% relative increase in those screened with ECG based on 95% confidence intervals (RR 0.58; 95%CI 0.23, 1.45). Heterogeneity was found to be high as measured with I2 statistic (71%).ConclusionThere is very low quality evidence ECG screening decreases risk of sudden cardiac death in young athletes and military members. Decisions need to consider evidence that ECG screening could also increase risk of sudden cardiac death based on the findings of meta-analysis.PROSPERO RegistrationCRD42019125560Key PointsECG screening of athletes has been shown to be more effective than history and physical examination alone to diagnose conditions which put the athlete at risk for sudden cardiac arrest or death (SCA/D). Few data are available to answer the question of the effectiveness of ECG screening in preventing SCA/D in young athletes.We identified only four published accounts (3 full papers and one conference abstract) of non-randomized trials reporting on the effectiveness of ECG screening to prevent SCA/D in young athletes and military members. The quality of the published evidence is judged to be of very low quality to answer the question of whether ECG screening prevents episodes of SCA/D. No difference was identified between screened and non-screened athletes in data synthesis of two of the published articles eligible for meta-analysis (RR 0.58; 95%CI 0.23, 1.45).

scholarly journals Screening electrocardiogram in young athletes and military members: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Aaron Lear ◽  
Niraj Patel ◽  
Chanda Mullen ◽  
Marian Simonson ◽  
Vince Leone ◽  
...  
Keyword(s):  
Absolute Risk ◽  
Meta Analysis ◽  
Sudden Cardiac Arrest ◽  
Absolute Risk Reduction ◽  
Risk Of Bias ◽  
Young Athletes ◽  
Conference Abstract ◽  
Relative Decrease ◽  
Increased Risk ◽  
Military Members

Abstract Objective: To determine the effect of electrocardiogram (ECG) screening on prevention of sudden cardiac arrest and death (SCA/D) in young athletes and military members. Data Sources: MEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORT discus, PEDro, and clinicaltrials.gov were searched from inception to dates between 2/21/19 and 7/29/19. Study Selection: Randomized and non-randomized controlled trials, where pre-participation examination including ECG was the primary intervention used to screen athletes or military 40 years of age or younger. Accepted controls were no screening, usual care, or pre-participation examination without ECG. 3 published studies , and one conference abstract were identified for inclusion. Data Extraction: In all four studies, risk of bias was assessed with the Cochrane risk of bias tool, and found to be generally high. Two studies had data extracted for random effects meta-analysis, and the remaining study and conference abstract were included in narrative review. Overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Data Synthesis: Four non-randomized studies (11,689,172 participants) were included, all at high risk of bias. Pooled data from two studies (n= 3,869,274; very low quality evidence) observed an inconclusive 42% relative decrease in risk of sudden cardiac death (RR 0.58; 95% CI 0.23, 1.45), equating to an absolute risk reduction of .0016% The findings were consistent with a potential 67% relative decrease to a 45% relative increased risk in participants screened with ECG. Heterogeneity was found to be high as measured with I2 statistic (71%). Data from the remaining study and abstract were similarly inconclusive. Conclusion: Existing evidence for the effect of ECG screening is inconclusive and of very low quality. Our meta-analysis observed that screening ECG may result in considerable benefit or harm to participants. Higher quality studies are needed to reduce this uncertainty. PROSPERO Registration: CRD42019125560

scholarly journals Incidence of sudden cardiac arrest and death in young athletes and military members: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Aaron Lear ◽  
Niraj Patel ◽  
Chanda Mullen ◽  
Marian Simonson ◽  
Vince Leone ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Incidence Rate ◽  
Meta Analysis ◽  
National Level ◽  
Sudden Cardiac Arrest ◽  
Rare Event ◽  
Risk Of Bias ◽  
Low Risk ◽  
Military Members

Abstract Objectives: The goals of this review are to evaluate the quality of the evidence on the incidence of sudden cardiac arrest and death (SCA/D) in athletes and military members; and to estimate annual incidence of SCA/D. Data Sources: MEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORT discus, PEDro, and clinicaltrials.gov were searched from inception to dates between 2/21/19–7/29/19. Study Selection: Studies which reported incidence of SCA/D or both in athletes, or military members under age 40 were eligible for inclusion. 40 studies were identified for inclusion Data Extraction: Risk of bias was assessed using a validated, customized tool for prevalence studies in all included studies. 12 were found to be low ROB, with the remaining 28 moderate or high ROB. Data was extracted for narrative review, and meta-analysis. Data Synthesis: Random-effects meta-analysis was performed in studies judged to be low risk of bias in two separate categories: 5 studies on regional or national level data including athletes at all levels, and both sexes included 130 events of SCD, with a total of 11,272,560 athlete years showing a cumulative incidence rate of 0.98 [95%CI: 0.62, 1.53] per 100,000 athlete years, with high heterogeneity with I2 of 78%; 3 Studies on competitive athletes aged 14 to 25 were combined, and included 183 events, and 17,798758 athlete years showing an incidence rate of 1.91[95%CI: 0.71; 5.14] per 100,000 athlete years with high heterogeneity with I2 of 97%. The remaining low risk of bias studies were in military members, and were not synthesized. Conclusion: The worldwide incidence of SCD is a rare event. Low risk of bias studies indicate incidence to be below 2 per 100,000 athlete years. Overall, the quality of the evidence available is low, but there are high quality individual studies to inform the question of incidence levels. PROSPERO Registration: CRD42019125560

scholarly journals Global incidence of sudden cardiac arrest in young athletes and military members: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Aaron Lear ◽  
Niraj Patel ◽  
Chanda Mullen ◽  
Marian Simonson ◽  
Vince Leone ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Incidence Rate ◽  
Meta Analysis ◽  
Large Population ◽  
Sudden Cardiac Arrest ◽  
Risk Of Bias ◽  
Low Risk ◽  
High Quality ◽  
Military Members

AbstractObjectivesThe goals of this review are to evaluate the quality of the evidence on the incidence of sudden cardiac arrest and death (SCA/D) in athletes and military members; and to estimate annual incidence of SCA/D.Data SourcesMEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORT discus, PEDro, and clinicaltrials.gov were searched from inception to dates between 2/21/19 and 7/29/19.Study SelectionStudies which reported incidence of SCA/D or both in athletes, or military members under age 40 were eligible for inclusion. 40 studies were identified for inclusionData ExtractionRisk of bias was assessed using a validated, customized tool for prevalence studies in all included studies. 12 were found to be low ROB, with the remaining 28 moderate or high ROB. Data was extracted for narrative review, and meta-analysis.Data SynthesisRandom-effects meta-analysis was performed in studies judged to be low risk of bias in two separate categories: 5 studies on regional or national level data including athletes at all levels, and both sexes included 130 events of SCD, with a total of 11,272,560 athlete years showing a cumulative incidence rate of 0.98 [95%CI: 0.62, 1.53] per 100,000 athlete years, with high heterogeneity with I2 of 78%; 3 Studies focusing on competitive athletes between the ages of 14 and 25 were combined, and included 183 events, and 17,798758 athlete years showing an incidence rate of 1.91[95%CI: 0.71; 5.14] per 100,000 athlete years with high heterogeneity with I2 of 97%.ConclusionThe worldwide incidence of SCD is a rare event. Low risk of bias studies indicate levels of SCD to be below 2 per 100,000 athlete years. Overall, the quality of the evidence available on the subject of SCA/D is low, but there are high quality individual studies to inform the question of incidence levels.PROSPERO RegistrationCRD42019125560Key PointsThere are several published articles which give a clear picture on the estimate of sudden cardiac arrest and death in athletes and military members, but the overall state of the literature has substantial risk of bias, with only 12 of 40 included articles at low risk of bias.Meta-analysis of sudden cardiac death was shown to be rare overall in athletes, with high quality, large population level studies synthesized to show a rate of 0.98 [95%CI: 0.62, 1.53] per 100,000 athlete years, and more focused studies on competitive younger athletes synthesized to show a rate 1.91[95%CI: 0.71; 5.14] per 100,000 athlete years. There was high heterogeneity present in both meta-analyses.

scholarly journals Predictors of sudden cardiac arrest in adolescents with mitral valve prolapse: an analysis of the nationwide inpatient sample

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Narasimhan ◽  
L Wu ◽  
C.H Lucas ◽  
K Bhatia ◽  
A Shah ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Family History ◽  
Sudden Cardiac Death ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Prolapse ◽  
Cardiac Death ◽  
Sudden Cardiac Arrest ◽  
Adolescent Patients ◽  
History Of

Abstract Background Mitral valve prolapse (MVP) is the most commonly encountered valvular pathology seen in 2–3% of the general population. Though traditionally regarded as a benign pathology, recent literature suggests that sudden cardiac death is significantly more common in these patients with estimates of 0.2–0.4%/year. The exact underlying mechanism of these higher rates of SCD remain poorly understood. In this study, we aim to identify predictors of sudden cardiac arrest (SCA) in an adolescent population. Methods We conducted a retrospective study using the AHRQ-HCUP National Inpatient Sample 2016-2017 for the years 2016-17. All patients (≤18 years) admitted with Mitral valve prolapse were identified using ICD-10 codes and further sub stratified based on presence or absence of sudden cardiac arrest (SCA). Baseline characteristics were obtained and multivariate regression analysis was utilized to identify potential predictors of SCA. Independent risk factors for in-hospital mortality were identified using a proportional hazards model. Complications were defined as per the Agency for Health Care Research and Quality guideline. Results We screened a total of 71,473,874 admissions in the NIS database to identify a total of 1,372 adolescent patients admitted with MVP in the years 2016–17. These patients were then sub-categorized based on presence or absence of SCA during the hospitalization. Our findings revealed that patients with SCA were generally slightly older (15y vs 13y, p=0.036, OR-1.1, p=0.007) and more likely female (83.3% vs 13%, p=0.227, OR – 3.55, p=0.57)). Interestingly, patients in the SCA cohort were noted to have almost 4 fold higher rates of Mitral regurgitation (66.6% vs 18.35%, p=0.008, OR-8.89, p=0.005) as well as family history of SCD (16.7% vs 4.1%, p=0.145, OR-4.65, p=0.14). Conclusions Presence of Mitral regurgitation and a family history of sudden cardiac death are associated with significantly higher rates of SCA in adolescent patients with mitral valve prolapse. Predictors of SCA in Adolescent MVP Funding Acknowledgement Type of funding source: None

Causes of Sudden Cardiac Death in Young Athletes and Non-athletes: Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Flavio D'Ascenzi ◽  
Francesca Valentini ◽  
Simone Pistoresi ◽  
Federica Frascaro ◽  
Pietro Piu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Meta Analysis ◽  
Young Athletes

scholarly journals Delayed occurrence of an accelerated idioventricular rhythm with alternating bundle branch block after myocardial infarction as predictor of sudden cardiac arrest: a case report

2020 ◽  
Author(s):  
Markus Bettin ◽  
Matthias Koopmann ◽  
Gerold Mönnig ◽  
Christian Pott
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Sudden Cardiac Arrest ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Bundle Branch Block ◽  
Permanent Pacemaker Implantation ◽  
Idioventricular Rhythm

Abstract Background Accelerated idioventricular rhythm (AIVR) is known as reperfusion arrhythmia in the setting of acute myocardial infarction (AMI). In healthy individuals, it is usually considered to be benign. Alternating bundle branch block (ABBB) often progresses to complete atrioventricular block requiring permanent pacemaker implantation. We report a case of delayed appearance of AIVR following myocardial infarction (MI) in combination with ABBB as precursor of sudden cardiac arrest due to ventricular fibrillation (VF). Case summary A 62-year-old male with pre-existing left bundle branch block (LBBB) was admitted with an acute non-ST segment elevation MI. He underwent successful percutaneous coronary intervention (PCI) of a subtotal proximal left anterior descending artery (LAD) stenosis. Before and after PCI the electrocardiogram (ECG) demonstrated sinus rhythm with LBBB. The patient was discharged 5 days after PCI, left ventricular function at this time was moderately reduced (ejection fraction of 40%). After another 5 days, the patient was admitted for elective cardiac rehabilitation. At this time, the ECG demonstrated an AIVR with right bundle branch block morphology. Due to ABBB, the patient was scheduled for permanent pacemaker implantation. Before pacemaker implantation could take place, the patient developed a sudden cardiac arrest due to VF and was successfully resuscitated. A follow-up coronary angiography revealed no novel lesions. A cardiac resynchronization therapy defibrillator was implanted for secondary prevention of sudden cardiac death. Discussion Delayed occurrence of AIVR in combination with ABBB following AMI could be a predictor of sudden cardiac death. These patients are probably at high risk for malignant ventricular arrhythmias.

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