Cardiac Dysrhythmias and Sports

Sudden unexpected death during athletic participation is the overriding consideration in advising individuals with dysrhythmias about participation in sports. The incidence of sudden death is 1 to 2 per 200 000 athletes per year and approximately 12 per year in US high school athletes.1 Between 5 and 22% of these deaths occur during sports or physical activities that include basketball, racquetball, jogging, football, soccer, and golf.2 The remainder occur during sedentary activities.2 Another potential risk for the athlete with a dysrhythmia is injury to self or others from syncope or near syncope while playing sports. The leading cause of sudden unexpected cardiac death is hypertrophic cardiomyopathy.1 A dysrhythmia of ventricular or supraventricular origin may be a significant factor in the sudden unexpected death of these individuals.1 Myocarditis is also a cause of sudden cardiac death. Severe dysrhythmia may be a prominent feature of myocarditis even in the absence of significant cardiac dysfunction.1 This diagnosis should be considered in an individual who has a recent sudden onset of a symptomatic dysrhythmia.3 Ventricular dysrhythmias with exercise are a potential cause of death in individuals with arrhythmogenic right ventricular dysplasia (a rare muscle disorder of the right ventricle).1 Sudden death resulting from dysrhythmia can occur with exertion or excitement in individuals who have hereditary syndromes that include prolongation of the QTc interval.3 Sudden death has also been associated with mitral valve prolapse (rarely) and with Wolff-Parkinson-White syndrome.3 MEDICAL HISTORY The patient's medical history is of critical importance. Dysrhythmias may be episodic and not apparent at the time of physical examination.