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Spencer R, Quraishi S. Athlete Screening and Sudden Cardiac Death. Pediatr Rev 2023; 44:669-681. [PMID: 38036435 DOI: 10.1542/pir.2023-005975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Robert Spencer
- Division of Pediatric Cardiology, Department of Pediatrics, Staten Island University Hospital, Northwell Health, Staten Island, NY
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Shahed Quraishi
- Division of Pediatric Cardiology, Department of Pediatrics, Staten Island University Hospital, Northwell Health, Staten Island, NY
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Amalie Wolthers S, Walther Jensen T, Nikolaj Blomberg S, Gelderman Holgersen M, Lippert F, Mikkelsen S, Mazur Hendriksen O, Torp-Pedersen C, Collatz Christensen H. Out-of-Hospital Cardiac Arrest related to exercise in the general population: Incidence, Survival and Bystander Response. Resuscitation 2022; 172:84-91. [DOI: 10.1016/j.resuscitation.2022.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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Grubic N, Hill B, Phelan D, Baggish A, Dorian P, Johri AM. Bystander interventions and survival after exercise-related sudden cardiac arrest: a systematic review. Br J Sports Med 2021; 56:410-416. [PMID: 34853034 DOI: 10.1136/bjsports-2021-104623] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the provision of bystander interventions and rates of survival after exercise-related sudden cardiac arrest (SCA). DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, PubMed, CINAHL, SPORTDiscus, Cochrane Library and grey literature sources were searched from inception to November/December 2020. STUDY ELIGIBILITY CRITERIA Observational studies assessing a population of exercise-related SCA (out-of-hospital cardiac arrests that occurred during exercise or within 1 hour of cessation of activity), where bystander cardiopulmonary resuscitation (CPR) and/or automated external defibrillator (AED) use were reported, and survival outcomes were ascertained. METHODS Among all included studies, the median (IQR) proportions of bystander CPR and bystander AED use, as well as median (IQR) rate of survival to hospital discharge, were calculated. RESULTS A total of 29 studies were included in this review, with a median study duration of 78.7 months and a median sample size of 91. Most exercise-related SCA patients were male (median: 92%, IQR: 86%-96%), middle-aged (median: 51, IQR: 39-56 years), and presented with a shockable arrest rhythm (median: 78%, IQR: 62%-86%). Bystander CPR was initiated in a median of 71% (IQR: 59%-87%) of arrests, whereas bystander AED use occurred in a median of 31% (IQR: 19%-42%) of arrests. Among the 19 studies that reported survival to hospital discharge, the median rate of survival was 32% (IQR: 24%-49%). Studies which evaluated the relationship between bystander interventions and survival outcomes reported that both bystander CPR and AED use were associated with survival after exercise-related SCA. CONCLUSION Exercise-related SCA occurs predominantly in males and presents with a shockable ventricular arrhythmia in most cases, emphasising the importance of rapid access to defibrillation. Further efforts are needed to promote early recognition and a rapid bystander response to exercise-related SCA.
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Affiliation(s)
- Nicholas Grubic
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada .,Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Braeden Hill
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Dermot Phelan
- Sports Cardiology Center, Atrium Health Sanger Heart and Vascular Institute, Charlotte, North Carolina, USA
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Dorian
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Amer M Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Athlete Preparticipation Physical Evaluation. Sports Med Arthrosc Rev 2021; 29:200-206. [PMID: 34730121 DOI: 10.1097/jsa.0000000000000330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Preparticipation evaluations (PPE) are both a traditional and legal requirement by many governing bodies for sport. The ideal goal of the PPE is safe participation in sport for athletes. This article provides an overview of common PPE elements and current best practice recommendations. Descriptions of every possible examination are published elsewhere and are beyond the intent of this article. Additional considerations for transgender, masters athletes, and Special Olympians are also outside the scope of this review, but are well covered in The Preparticipation Physical Evaluation, fifth edition monograph.
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Armstrong TA, Neil ER, Pennington AM, Mair KEF, Eberman LE. Athletic Trainers' Perceptions of Accessibility to Necessary Resources for Those Working Per Diem Services. J Athl Train 2021; 56:112-122. [PMID: 33259595 DOI: 10.4085/1062-6050-0095.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT As the demand for athletic training services has grown, the per diem athletic training setting has expanded to fulfill this need. Per diem services are provided by athletic trainers (ATs) who are hired as independent contractors for short time periods. These service opportunities help to increase access to care for medically underserved populations; however, due to the transient nature of the work, the quality of care may be compromised. OBJECTIVE To examine current practices in per diem services and evaluate ATs' accessibility to resources. DESIGN Cross-sectional study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS A total of 448 participants responded (access rate = 9.57%), of whom 210 were ineligible (46.9%). Of those who were eligible, 192 participants completed the entire tool (completion rate = 80.7%, age = 38 ± 12 years, years certified = 14 ± 11, years providing per diem services = 8 ± 8). MAIN OUTCOME MEASURE(S) The survey comprised 3 sections: (1) demographics, (2) accessibility to resources and influence on patient care, and (3) domains of athletic training while providing per diem services. Resources assessed included those that are relevant to ATs practicing in accordance with the Board of Certification "Standards of Professional Practice." The final instrument included approximately 30 questions (depending on display logic) and took an average of 12 minutes to complete. RESULTS Of the 11 primary resources assessed, participants had limited accessibility to 6. Critical resources related to informatics, legalities, and health care delivery were often not available, were seen as unimportant to providing medical services, or both. CONCLUSIONS Participants indicated varied perceptions about the need for and access to these resources. Yet such resources contribute to the creation of a safe infrastructure for providing medical services and should be part of the routine dialogue regarding independent contracting.
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Sports-Related Sudden Cardiac Arrest in Germany. Can J Cardiol 2021; 37:105-112. [DOI: 10.1016/j.cjca.2020.03.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/16/2020] [Accepted: 03/16/2020] [Indexed: 11/17/2022] Open
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Exercise related sudden cardiac death (SCD) in the young - Pre-mortal characterization of a Swedish nationwide cohort, showing a decline in SCD among athletes. Resuscitation 2019; 144:99-105. [PMID: 31560990 DOI: 10.1016/j.resuscitation.2019.09.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/15/2019] [Accepted: 09/16/2019] [Indexed: 02/07/2023]
Abstract
AIMS To study the frequency, etiology, and premortal abnormalities in exercise-related sudden cardiac death (SCD) in the young in Sweden. METHODS All subjects with SCD in 10-35-year olds in Sweden during 2000-10, were included (n = 514). Information about each case was retrieved from death certifications, autopsy- and medical records. The number of SCD in athletes was compared to national figures from 1992-99. RESULTS Exercise-related SCD occurred in 12% (62/514) of the SCD-population, a majority being men (56/62; 90%). Cardiopulmonary resuscitation (CPR) was started in 87% (54/62). In total, 48% (30/62), had a cardiac diagnosis, symptoms, family history and/or ECG-changes, before the fatal event. The most prevalent autopsy diagnosis was sudden arrhythmic death syndrome (15/62; 24%). The frequency of hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC) was significantly higher in exercise-related SCD compared to non-exertional SCD. Exercise-related SCD was more common in athletes (21/29) than in non-athletes (41/485) (P < 0.0001). The total number of SCDs/year in athletes 15-35 years old, are approximately halved in 2000-10 compared to the years 1992-99. CONCLUSION The increased risk of exercise-related SCD in HCM and ARVC underlines the importance of early detection and eligibility recommendations. There is a major reduction in deaths among athletes in the 2000s, compared to the previous decade. These results may partly be explained by improved acute preparedness for sudden cardiac arrest (CPR, defibrillation), but as a substantial percentage have preceding risk factors, such as symptoms and ECG-abnormalities, increased cardiac screening and increased general awareness, may also play a role.
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Parsons JT, Anderson SA, Casa DJ, Hainline B. Preventing Catastrophic Injury and Death in Collegiate Athletes: Interassociation Recommendations Endorsed by 13 Medical and Sports Medicine Organisations. J Athl Train 2019; 54:843-851. [PMID: 31536387 DOI: 10.4085/1062-6050-54.085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Second Safety in College Football Summit resulted in interassociation consensus recommendations for three paramount safety issues in collegiate athletics: (1) independent medical care for collegiate athletes; (2) diagnosis and management of sport-related concussion; and (3) year-round football practice contact for collegiate athletes. This document, the fourth arising from the 2016 event, addresses the prevention of catastrophic injury, including traumatic and non-traumatic death, in collegiate athletes. The final recommendations in this document are the result of presentations and discussions on key items that occurred at the summit. After those presentations and discussions, endorsing organisation representatives agreed on 18 foundational statements that became the basis for this consensus paper that has been subsequently reviewed by relevant stakeholders and endorsing organisations. This is the final endorsed document for preventing catastrophic injury and death in collegiate athletes. This document is divided into the following components. (1) Background-this section provides an overview of catastrophic injury and death in collegiate athletes. (2) Interassociation recommendations: preventing catastrophic injury and death in collegiate athletes-this section provides the final recommendations of the medical organisations for preventing catastrophic injuries in collegiate athletes. (3) Interassociation recommendations: checklist-this section provides a checklist for each member school. The checklist statements stem from foundational statements voted on by representatives of medical organisations during the summit, and they serve as the primary vehicle for each member school to implement the prevention recommendations. (4) References-this section provides the relevant references for this document. (5) Appendices-this section lists the foundational statements, agenda, summit attendees and medical organisations that endorsed this document.
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Affiliation(s)
- John T Parsons
- Sport Science Institute, National Collegiate Athletic Association, Indianapolis, IN
| | | | | | - Brian Hainline
- Sport Science Institute, National Collegiate Athletic Association, Indianapolis, IN
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Parsons JT, Anderson SA, Casa DJ, Hainline B. Preventing catastrophic injury and death in collegiate athletes: interassociation recommendations endorsed by 13 medical and sports medicine organisations. Br J Sports Med 2019; 54:208-215. [PMID: 31537549 DOI: 10.1136/bjsports-2019-101090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2019] [Indexed: 11/03/2022]
Abstract
The following organisations endorsed this document: American Association of Neurological Surgeons, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine, College Athletic Trainers' Society, Collegiate Strength and Conditioning Coaches Association, Congress of Neurological Surgeons, Korey Stringer Institute, National Athletic Trainers' Association, National Strength and Conditioning Association, National Operating Committee for Standards on Athletic Equipment, Sports Neuropsychology Society. The following organisation has affirmed the value of this document: American Academy of Neurology. The Second Safety in College Football Summit resulted in interassociation consensus recommendations for three paramount safety issues in collegiate athletics: (1) independent medical care for collegiate athletes; (2) diagnosis and management of sport-related concussion; and (3) year-round football practice contact for collegiate athletes. This document, the fourth arising from the 2016 event, addresses the prevention of catastrophic injury, including traumatic and non-traumatic death, in collegiate athletes. The final recommendations in this document are the result of presentations and discussions on key items that occurred at the summit. After those presentations and discussions, endorsing organisation representatives agreed on 18 foundational statements that became the basis for this consensus paper that has been subsequently reviewed by relevant stakeholders and endorsing organisations. This is the final endorsed document for preventing catastrophic injury and death in collegiate athletes. This document is divided into the following components. (1) Background-this section provides an overview of catastrophic injury and death in collegiate athletes. (2) Interassociation recommendations: preventing catastrophic injury and death in collegiate athletes-this section provides the final recommendations of the medical organisations for preventing catastrophic injuries in collegiate athletes. (3) Interassociation recommendations: checklist-this section provides a checklist for each member school. The checklist statements stem from foundational statements voted on by representatives of medical organisations during the summit, and they serve as the primary vehicle for each member school to implement the prevention recommendations. (4) References-this section provides the relevant references for this document. (5) Appendices-this section lists the foundational statements, agenda, summit attendees and medical organisations that endorsed this document.
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Affiliation(s)
- John T Parsons
- Sport Science Institute, National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
| | | | - Douglas J Casa
- Kinesiology, University of Connecticut, Storrs, Connecticut, USA
| | - Brian Hainline
- Sport Science Institute, National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
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Tsuda T, Geary EM, Temple J. Significance of automated external defibrillator in identifying lethal ventricular arrhythmias. Eur J Pediatr 2019; 178:1333-1342. [PMID: 31297625 DOI: 10.1007/s00431-019-03421-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/21/2019] [Accepted: 06/30/2019] [Indexed: 12/24/2022]
Abstract
Automated electrical defibrillator (AED) is critical in saving children who develop unexpected cardiac arrest (CA), but its diagnostic capacity is not fully acknowledged. Retrospective cohort study of patients with aborted sudden cardiac death (SCD) was performed. Twenty-five patients (14 males) aged 1.3 to 17.5 years who presented with CA survived with prompt cardiopulmonary resuscitation. Eighteen patients had no prior cardiac diagnosis. Cardiac arrest occurred in 10 patients with more than moderate exercise, in 7 with light exercise, and in 8 at rest (including one during sleep). Twenty-two patients were resuscitated with AED, all of which were recognized as a shockable cardiac rhythm. Thorough investigations revealed 6 ion channelopathies (4 catecholaminergic polymorphic ventricular tachycardia, one long QT syndrome, and one Brugada syndrome), 5 congenital heart disease (including 2 with coronary artery obstruction), 6 cardiomyopathies, 2 myocarditis, and 2 miscellaneous. Four patients had no identifiable heart disease. In 5 patients, the downloaded AED-recorded rhythm strip delineated the underlying arrhythmias and their responses to electrical shocks. Four patients who presented with generalized seizure at rest were initially managed for seizure disorder until AED recording identified lethal ventricular arrhythmias.Conclusions: AED reliably identifies the underlying lethal ventricular arrhythmias in addition to aborting SCD. What is Known: • Although infrequent in children, sudden cardiac death (SCD) is often an unexpected and tragic event. The etiology is diverse and sometimes remains unknown despite extensive investigations. • Automated external defibrillator (AED) is both therapeutic in aborting SCD and diagnostic in identifying the underlying lethal ventricular arrhythmias. However, the diagnostic aspect of AED is under-acknowledged by most medical providers. What is New: • Four of 25 patients (16%) were initially managed for possible seizure disorders until AED recording identified lethal ventricular arrhythmia. • The AED recording of the lethal arrhythmia during cardiopulmonary resuscitation (CPR) should always be obtained as it plays a crucial role in the decision-making process before ICD implantation. All medical providers should become familiar with downloading cardiac rhythm strips from AED when requested.
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Affiliation(s)
- Takeshi Tsuda
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA. .,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Elaine M Geary
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA
| | - Joel Temple
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Exercise-related out-of-hospital cardiac arrest in Victoria, Australia. Resuscitation 2019; 139:57-64. [PMID: 30981883 DOI: 10.1016/j.resuscitation.2019.03.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/18/2019] [Accepted: 03/31/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Characteristics and outcomes of exercise-related out-of-hospital cardiac arrests (OHCA) are not well described in Australia. METHODS This was a retrospective observational study of non-exercise-related aetiology and exercise-related OHCAs from the Victorian Ambulance Cardiac Arrest Registry between 2008 and 2016, including 12-month quality of life data from 2010 to 2016. Exercise-related OHCA was defined as taking place during or within 1 h of at least moderate intensity exercise. Descriptive statistics and adjusted logistic regression analyses were performed. RESULTS During the study period there were 482 exercise-related and 33,358 non-exercise-related OHCAs. Jogging/running were the most frequent precipitating sports. The incidence rate of exercise-related OHCA was low (<1 per 100,000 person-years). Compared to non-exercise-related aetiology, exercise-related OHCAs were younger (mean 54 versus 70 years, p < 0.001) and more likely to present in an initial shockable rhythm (85% versus 18%, p < 0.001). Bystander CPR, and bystander or EMS defibrillation at any time, were more common among exercise-related arrests (93% versus 38%, p < 0.001 and 91% versus 24%, p < 0.001, respectively). A public access defibrillator was used in 24% of shockable exercise-related OHCAs compared with 4% of non-exercise-related OHCAs (p < 0.001). After adjustment for arrest characteristics, exercise-related OHCAs were more likely to survive to hospital discharge (50% versus 14%, p < 0.001; adjusted odds ratio [AOR] = 1.56, 95% confidence interval [CI] 1.25-1.96, p < 0.001) and survive to 12-months with good functional recovery (72% versus 62%, p = 0.012; AOR = 1.57, 95% CI 1.08-2.28, p = 0.018). CONCLUSIONS Exercise-related OHCAs were associated with better short- and long-term prognoses compared to non-exercise-related OHCAs. The underlying factors associated with this survival benefit warrant further investigation.
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Drezner JA, Peterson DF, Siebert DM, Thomas LC, Lopez-Anderson M, Suchsland MZ, Harmon KG, Kucera KL. Survival After Exercise-Related Sudden Cardiac Arrest in Young Athletes: Can We Do Better? Sports Health 2018; 11:91-98. [PMID: 30204540 PMCID: PMC6299352 DOI: 10.1177/1941738118799084] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND: Sudden cardiac arrest (SCA) is the leading cause of death in young athletes during sports. HYPOTHESIS: Survival after SCA in young athletes is variable. STUDY DESIGN: Prospective, active surveillance study. LEVEL OF EVIDENCE: Level 3. METHODS: From July 1, 2014, to June 30, 2016, exercise-related SCA in competitive young athletes was identified through a systematic search of traditional and social media sources, direct reporting to the National Center for Catastrophic Sports Injury Research, searching of the National Collegiate Athletic Association Resolutions List, regular communication with national and state high school athletic associations, and review of cases in the Parent Heart Watch database. RESULTS: A total of 132 cases were identified during the 2-year study period (mean patient age, 16 years; age range, 11-27 years; 84% male; 51% white non-Hispanic/Latino, 30% black/African American, and 11% white Hispanic/Latino). High school athletes accounted for 78 (59%) cases, with 28 (21%) in middle school and 15 (11%) in college athletes. Overall survival was 48% (95% CI, 40%-57%; 64 survivors, 68 deaths). Survival was similar in male versus female athletes but higher in white non-Hispanic/Latino (40/67; 60%) versus black/African American (13/39; 33%) athletes (difference, 27%; 95% CI, 7%-45%; P = 0.008) and white non-Hispanic/Latino versus all minority (18/59; 31%) athletes (difference, 29%; 95% CI, 13%-46%; P = 0.001). Basketball accounted for 30% of cases, followed by football (25%), track/cross-country (12%), and soccer (11%). The majority (93%) of cases were witnessed. If a certified athletic trainer was on-site and involved in the resuscitation, 83% of athletes survived. If an on-site automated external defibrillator was used in the resuscitation, 89% of athletes survived. CONCLUSION: Exercise-related SCA in young, competitive athletes is typically witnessed, providing an opportunity for rapid resuscitation. Additional research is needed to identify factors that affect survival in different athlete populations. CLINICAL RELEVANCE: Public access defibrillator programs should be universal in schools and youth sporting venues and have the potential to increase survival after SCA in young athletes.
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Affiliation(s)
- Jonathan A. Drezner
- Jonathan A. Drezner, MD, Department of Family Medicine, Director, UW Medicine Center for Sports Cardiology, University of Washington, Box 354060, Seattle, WA 98195-4060 () (Twitter: @DreznerJon)
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Guenancia C, Garcia R. [Is it possible to practice sports with an implantable cardioverter-defibrillator?]. Presse Med 2018; 47:792-797. [PMID: 29909164 DOI: 10.1016/j.lpm.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/14/2018] [Indexed: 11/29/2022] Open
Abstract
Why? The potential risks of sport for an ICD recipient include appropriate and inappropriate shocks, device damage and worsening of the underlying cardiopathy. These risks should be compared to the physical and psychological benefits of exercise. Where? Due to different medico-legal contexts and considering the results of recent studies, the new US guidelines are more permissive than the European guidelines regarding sport practice in ICD recipients. Who? The underlying context (structural or electrical cardiopathy, psychological impact) should be assessed before any decision is taken. What sport? The intensity and duration of the exercise, the environment, the type of sport (bodily contact sports or compromising the costoclavicular area) and the potential consequences for the patient or the spectators of a possible loss of consciousness must to be anticipated. How? The patient's information on the consequences of the ICD on his subsequent physical activity must be delivered before the device implantation. In addition, the type and programming of the ICD must be personalized according to the sport. When? The patient should wait at least 6 weeks after ICD implantation to return to leisure sport and after an exercise test has been performed. After a ventricular arrhythmia, the patient must wait 3 months before returning to sport.
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Affiliation(s)
- Charles Guenancia
- University Hospital, department of cardiology, 21000 Dijon, France; PEC2, EA 7460, 21000 Dijon, France.
| | - Rodrigue Garcia
- University Hospital, department of cardiology, 86000 Poitiers, France
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Fuchs SM, Wright J, Adirim T, Agus MS, Callahan J, Gross T, Lane N, Lee L, Mazor S, Mahajan P, Timm N. Advocating for Life Support Training of Children, Parents, Caregivers, School Personnel, and the Public. Pediatrics 2018; 141:peds.2018-0705. [PMID: 29793985 DOI: 10.1542/peds.2018-0705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatric cardiac arrest in the out-of-hospital setting is a traumatic event for family, friends, caregivers, classmates, and school personnel. Immediate bystander cardiopulmonary resuscitation and the use of automatic external defibrillators have been shown to improve survival in adults. There is some evidence to show improved survival in children who receive immediate bystander cardiopulmonary resuscitation. Pediatricians, in their role as advocates to improve the health of all children, are uniquely positioned to strongly encourage the training of children, parents, caregivers, school personnel, and the lay public in the provision of basic life support, including pediatric basic life support, as well as the appropriate use of automated external defibrillators.
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Affiliation(s)
| | - Joseph Wright
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Terry Adirim
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Michael S.D. Agus
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - James Callahan
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Toni Gross
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Natalie Lane
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Lois Lee
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Suzan Mazor
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Prashant Mahajan
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Nathan Timm
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
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Inherited primary arrhythmia disorders: cardiac channelopathies and sports activity. Herz 2018; 45:142-157. [PMID: 29744527 DOI: 10.1007/s00059-018-4706-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/25/2018] [Accepted: 04/14/2018] [Indexed: 01/02/2023]
Abstract
Sudden cardiac death (SCD) in an apparently healthy individual is a tragedy. It is important to identify the cause of death and to prevent SCD in potentially at-risk family members. Inherited primary arrhythmia disorders are associated with exercise-related SCD. Despite the well-known benefits of exercise, exercise restriction has been a historical mainstay of therapy for these conditions. However, since familiarity with inherited arrhythmia conditions has increased and patients are often children and young adults, it is necessary to reassess the treatment guidelines regarding exercise constraints. The aim of this review is to analyze the risk of exercise-induced SCD in patients with inherited cardiac conditions and explore the challenges faced when advising patients about exercise limitations. We searched for publications on cardiac channelopathies in PubMed with the following medical subject headings (MeSH): "long QT syndrome"; "short QT syndrome"; "Brugada syndrome"; and "catecholaminergic polymorphic ventricular tachycardia". The abstracts of these articles were scanned, and articles of relevance, along with pertinent references, were read in full. The analysis was restricted to reports published in English. The findings of this analysis suggest that exercise with low-to-moderate cardiovascular demand may be possible under regular clinical follow-up in inherited primary arrhythmia disorders. Recent data show that patients with inherited primary arrhythmia disorders are at low risk for events once a comprehensive treatment program has been established. Recreational activity is likely safe for these individuals, with personalized management based on individual patient preferences and priorities.
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Osterman M, Claiborne T, Liberi V. Radius of Care in Secondary Schools in the Midwest: Are Automated External Defibrillators Sufficiently Accessible to Enable Optimal Patient Care? J Athl Train 2018; 53:410-415. [PMID: 29693422 DOI: 10.4085/1062-6050-536-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Sudden cardiac arrest is the leading cause of death among young athletes. According to the American Heart Association, an automated external defibrillator (AED) should be available within a 1- to 1.5-minute brisk walk from the patient for the highest chance of survival. Secondary school personnel have reported a lack of understanding about the proper number and placement of AEDs for optimal patient care. OBJECTIVE To determine whether fixed AEDs were located within a 1- to 1.5-minute timeframe from any location on secondary school property (ie, radius of care). DESIGN Cross-sectional study. SETTING Public and private secondary schools in northwest Ohio and southeast Michigan. PATIENTS OR OTHER PARTICIPANTS Thirty schools (24 public, 6 private) volunteered. MAIN OUTCOME MEASURE(S) Global positioning system coordinates were used to survey the entire school properties and determine AED locations. From each AED location, the radius of care was calculated for 3 retrieval speeds: walking, jogging, and driving a utility vehicle. Data were analyzed to expose any property area that fell outside the radius of care. RESULTS Public schools (37.1% ± 11.0%) possessed more property outside the radius of care than did private schools (23.8% ± 8.0%; F1,28 = 8.35, P = .01). After accounting for retrieval speed, we still observed differences between school types when personnel would need to walk or jog to retrieve an AED ( F1.48,41.35 = 4.99, P = .02). The percentages of school property outside the radius of care for public and private schools were 72.6% and 56.3%, respectively, when walking and 34.4% and 12.2%, respectively, when jogging. Only 4.2% of the public and none of the private schools had property outside the radius of care when driving a utility vehicle. CONCLUSION Schools should strategically place AEDs to decrease the percentage of property area outside the radius of care. In some cases, placement in a centralized location that is publicly accessible may be more important than the overall number of AEDs on site.
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Link MS. Sudden cardiac death in the young: Epidemiology and overview. CONGENIT HEART DIS 2017; 12:597-599. [PMID: 28618149 DOI: 10.1111/chd.12494] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/20/2017] [Indexed: 11/26/2022]
Abstract
Sudden cardiac death (SCD), particularly in the young athlete, is a rare though devastating event for families, institutions, and communities at large. It can also affect the nonathlete and occur at rest, although most commonly associated with exercise activities and/or sports participation. Common causes of SCD include cardiomyopathies, particularly hypertrophic cardiomyopathy in the United States, congenital coronary artery anomalies, channelopathies, among others. This report will explore an overview of the prevalence and causes of SCD in the young.
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Affiliation(s)
- Mark S Link
- Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas, USA
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18
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Abstract
Sudden cardiac arrest (SCA) in the pediatric population is a rare and potentially devastating occurrence. An understanding of the differential diagnosis for the etiology of the cardiac arrest allows for the most effective emergency care and provides the patient with the best possible outcome. Pediatric SCA can occur with or without prodromal symptoms and may occur during exercise or rest. The most common cause is arrhythmia secondary to an underlying channelopathy, cardiomyopathy, or myocarditis. After stabilization, evaluation should include electrocardiogram, chest radiograph, and echocardiogram. Management should focus on decreasing the potential for recurring arrhythmia, maintaining cardiac preload, and thoughtful medication use to prevent exacerbation of the underlying condition. The purpose of this review was to provide the emergency physician with a concise and current review of the incidence, differential diagnosis, and management of pediatric patients presenting with SCA.
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Furlanello F, Inama G, Inama L, Cappato R. Sudden unexpected cardiac death as the first symptom in young people: some useful clinical information from a systematic standardized anatomical study. J Cardiovasc Med (Hagerstown) 2016; 17:393-5. [PMID: 27116233 DOI: 10.2459/jcm.0000000000000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Francesco Furlanello
- aArrhythmia and Electrophysiology Center, IRCCS Humanitas Research Hospital, Milan, & Humanitas Gavazzeni Hospital, Bergamo bDepartment of Cardiology, Clinical Institute Figlie di San Camillo, Cremona cCardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia, Brescia, Italy
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Harmon KG, Drezner JA, O'Connor FG, Asplund C, Finnoff JT. Should Electrocardiograms Be Part of the Preparticipation Physical Examination? PM R 2016; 8:S24-35. [PMID: 26972265 DOI: 10.1016/j.pmrj.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Kimberly G Harmon
- Sports Medicine Section, Departments of Family Medicine and Orthopaedics and Sports Medicine, University of Washington, Sports Medicine Center at Husky Stadium UW Medicine, Seattle, WA(∗)
| | - Jonathan A Drezner
- Sports Medicine Section, Departments of Family Medicine and Orthopaedics and Sports Medicine, University of Washington, Sports Medicine Center at Husky Stadium UW Medicine, Seattle, WA(†)
| | - Francis G O'Connor
- Military and Emergency Medicine, Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD(‡)
| | - Chad Asplund
- Athletic Medicine, Health Services Division, Georgia Southern University, Statesboro, GA(§)
| | - Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester; and Mayo Clinic Sports Medicine Center, 600 Hennepin Ave, #310, Minneapolis, MN 55403(‖).
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21
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Edwards MJ, Fothergill RT. Exercise-related sudden cardiac arrest in London: incidence, survival and bystander response. Open Heart 2015; 2:e000281. [PMID: 26468401 PMCID: PMC4600248 DOI: 10.1136/openhrt-2015-000281] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/26/2015] [Accepted: 08/27/2015] [Indexed: 11/30/2022] Open
Abstract
Objective The study aimed to (1) establish the incidence of exercise-related sudden cardiac arrest (SCA) in London, (2) investigate survival from exercise-related SCA and (3) examine factors related to survival. Method This retrospective observational study examined 2 years’ data from the London Ambulance Service (LAS) cardiac arrest registry for patients in whom resuscitation was attempted following an out-of-hospital cardiac arrest (OHCA), a cardiac cause was presumed and the arrest occurred during or within 1 h of exercise. Results The incidence of exercise-related SCA in London was estimated to be 0.6 per 100 000 person-years which equated to 0.5% of all OHCA, and 1.5% of all OHCA with presumed cardiac aetiology and resuscitation attempted. The majority of cases were male and the incidence increased from age 40 years. Just under one-third of patients survived to hospital discharge. Survival in the Utstein comparator group (cases with presumed cardiac aetiology, resuscitation attempted, bystander witnessed and a presenting cardiac rhythm of ventricular fibrillation or tachycardia) was higher at 42%. Survival was significantly associated with initial cardiac rhythm (χ2=17.5, df=2, p<0.001) and bystander defibrillation (Fisher's exact test, p<0.05). Conclusions Incidence of exercise-related SCA in the general population in London is rare. Survival following exercise-related SCA was considerably higher than survival for all OHCA with presumed cardiac aetiology and resuscitation attempted attended by the LAS during the same period. The major limitation of the study is the likely under identification of cases of exercise-related SCA.
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Affiliation(s)
- Melanie J Edwards
- Clinical Audit & Research Unit , London Ambulance Service NHS Trust , London , UK
| | - Rachael T Fothergill
- Clinical Audit & Research Unit , London Ambulance Service NHS Trust , London , UK
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22
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Lear A, Hoang MH, Zyzanski SJ. Preventing Sudden Cardiac Death: Automated External Defibrillators in Ohio High Schools. J Athl Train 2015; 50:1054-8. [PMID: 26381367 DOI: 10.4085/1062-6050-50.8.01] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Ohio passed legislation in 2004 for optional public funding of automated external defibrillators (AEDs) in all Ohio high schools. OBJECTIVE To report occurrences of sudden cardiac arrest in which AEDs were used in Ohio high schools and to evaluate the adherence of Ohio high schools with AEDs to state law and published guidelines on AEDs and emergency action plans (EAPs) in schools. DESIGN Cross-sectional survey. SETTING Web-based survey. PATIENTS OR OTHER PARTICIPANTS A total of 264 of 827 schools that were members of the Ohio High School Athletic Association. MAIN OUTCOME MEASURE(S) We surveyed schools on AED use, AED maintenance, and EAPs. RESULTS Twenty-five episodes of AED deployment at 22 schools over an 11-year period were reported; 8 (32%) involved students and 17 (68%) involved adults. The reported survival rate was 60% (n = 15). Most events (n = 20, 80%) in both students and adults occurred at or near athletic facilities. The annual use rate of AEDs was 0.7%. Fifty-three percent (n = 140) of schools reported having an EAP in place for episodes of cardiac arrest. Of the schools with EAPs, 57% (n = 80) reported having rehearsed them. CONCLUSIONS Our data supported the placement of AEDs in high schools given the frequency of use for sudden cardiac arrest and the survival rate reported. They also suggested the need for increased awareness of recommendations for EAPs and the need to formulate and practice EAPs. School EAPs should emphasize planning for events in the vicinity of athletic facilities.
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Affiliation(s)
- Aaron Lear
- Center for Family Medicine, Akron General Medical Center, OH
| | - Minh-Ha Hoang
- Department of Family Medicine, Saint Mary's Medical Group, Maryland Heights, MO
| | - Stephen J Zyzanski
- Department of Family Medicine, Case Western Reserve University, Cleveland, OH
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Solberg EE, Borjesson M, Sharma S, Papadakis M, Wilhelm M, Drezner JA, Harmon KG, Alonso JM, Heidbuchel H, Dugmore D, Panhuyzen-Goedkoop NM, Mellwig KP, Carre F, Rasmusen H, Niebauer J, Behr ER, Thiene G, Sheppard MN, Basso C, Corrado D. Sudden cardiac arrest in sports – need for uniform registration: A Position Paper from the Sport Cardiology Section of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Prev Cardiol 2015; 23:657-67. [DOI: 10.1177/2047487315599891] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/21/2015] [Indexed: 12/16/2022]
Affiliation(s)
- EE Solberg
- Diakonhjemmet Hospital, Department of Medicine, Oslo, Norway
| | - M Borjesson
- Swedish School of Sport and Health Sciences, Stockholm, Sweden; Karolinska University Hospital
| | - S Sharma
- St George’s University of London, UK
| | | | - M Wilhelm
- University Clinic for Cardiology, Cardiovascular Prevention, Rehabilitation & Sports Medicine, Inselspital, Bern, Switzerland
| | - JA Drezner
- Department of Family Medicine, University of Washington, Seattle, USA
| | - KG Harmon
- Department of Family Medicine, University of Washington, Seattle, USA
| | - JM Alonso
- Aspetar, Qatar Orthopedics and Sports Medicine Hospital, Sports Medicine Department, Doha, Qatar
| | - H Heidbuchel
- Cardiology – Arrhythmology, University Hospital Leuven, Belgium
| | - D Dugmore
- Department of Sports medicine, Perform Sports medicine centre, Burton upon Trent, UK
| | - NM Panhuyzen-Goedkoop
- Radboud University Nijmegen MC, The Netherlands; Sports Medical Centre Papendal Arnhem, The Netherlands
| | - K-P Mellwig
- Department of Cardiology, Heart and Diabetes Centre NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - F Carre
- Pontchaillou Hospital, Rennes, France; INSERM U1099, Rennes, France
| | - H Rasmusen
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - J Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - ER Behr
- St George’s University of London, UK
| | - G Thiene
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | | | - C Basso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - D Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
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24
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Marijon E, Bougouin W, Karam N, Beganton F, Lamhaut L, Perier MC, Benameur N, Tafflet M, Beal G, Hagege A, Le Heuzey JY, Desnos M, Spaulding C, Carré F, Dumas F, Celermajer DS, Cariou A, Jouven X. Survival from sports-related sudden cardiac arrest: In sports facilities versus outside of sports facilities. Am Heart J 2015; 170:339-345.e1. [PMID: 26299232 DOI: 10.1016/j.ahj.2015.03.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 03/30/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND We sought to evaluate frequency, characteristics, and outcomes of sudden cardiac arrest (SCA) during sports activities according to the location of occurrence (in sports facilities vs those occurring outside of sports facilities). METHODS AND RESULTS This is an observational 5-year prospective national French survey of subjects 10 to 75 years old presenting with SCA during sports (2005-2010), in 60 French administrative regions (covering a population of 35 million people). Of the 820 SCA during sports, 426 SCAs (52%) occurred in sports facilities. Overall, a substantially higher survival rate at hospital discharge was observed among SCA in sports facilities (22.8%, 95% CI 18.8-26.8) compared to those occurring outside (8.0%, 95% CI 5.3-10.7) (P < .0001). Patients with SCA in sports facilities were younger (42.1 vs 51.3 years, P < .0001) and less frequently had known cardiovascular diseases (P < .0001). The events were more often witnessed (99.8% vs 84.9%, 0.0001), and bystander cardiopulmonary resuscitation was more frequently initiated (35.4% vs 25.9%, P = .003). Delays of intervention were significantly shorter when SCA occurred in sports facilities (9.3 vs 13.6, P=0.03), and the proportion of initially shockable rhythm was higher (58.8% vs 33.1%, P < .0001). Better survival in sports facilities was mainly explained by concomitant circumstances of occurrence (adjusted odds ratio 1.48, 95% CI 0.88-2.49, P = .134). CONCLUSIONS Sports-related SCA is not a homogeneous entity. The 3-fold higher survival rate reported among sports-related SCA is mainly due to cases that occur in sports facilities, whereas SCA during sports occurring outside of sports facilities has the usual very low rate of survival.
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Affiliation(s)
- Eloi Marijon
- Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France; Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Wulfran Bougouin
- Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France; Intensive Care Unit, Cochin Hospital, Paris, France
| | - Nicole Karam
- Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France; Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Frankie Beganton
- Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France
| | - Lionel Lamhaut
- Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France; Intensive Care Unit and SAMU 75, Necker Enfants-Malades Hospital, Paris, France
| | - Marie-Cécile Perier
- Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France
| | - Nordine Benameur
- Lille 2 University Hospital, University of Lille, Emergency Department and SAMU 59, Lille, France
| | - Muriel Tafflet
- Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France
| | - Guillaume Beal
- Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France
| | - Albert Hagege
- Paris Descartes University, Paris, France; Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Jean-Yves Le Heuzey
- Paris Descartes University, Paris, France; Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Michel Desnos
- Paris Descartes University, Paris, France; Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Christian Spaulding
- Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France; Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Francois Carré
- Rennes 1 University, Pontchaillou Hospital, INSERM UMR, Rennes, France
| | - Florence Dumas
- Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France
| | | | - Alain Cariou
- Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Center, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France; Cardiology Department, Georges Pompidou European Hospital, Paris, France.
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25
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Student athletes, sudden cardiac death, and lifesaving legislation: a review of the literature. J Pediatr Health Care 2015; 29:233-42. [PMID: 25577720 DOI: 10.1016/j.pedhc.2014.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 11/10/2014] [Accepted: 11/11/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this article is to present findings of a literature review examining the use of automatic external defibrillators (AEDs) for student athletes experiencing sudden cardiac arrest and variances in state legislation regarding the mandatory placement of AEDs in school gymnasiums and athletic fields. METHODS A broad search of computerized databases was conducted utilizing PubMed, Medline, CINHAHL, and the Cochrane Databases, which provided a broad but not exhaustive review of the current literature related to student athletes, sudden cardiac death, and the use of AEDs. The articles were evaluated and graded using Stetler's strength of evidence guidelines. FINDINGS A total of 17 articles are included in this literature review (Stetler's Grade I, n = 1; Grade II, n = 2; Grade III, n =2; Grade IV, n = 5; Grade V, n = 3; and Grade VI, n = 4). The literature produced few meta-analyses of controlled studies, experimental studies, and quasi-experimental studies on the topic of student athletes at risk for sudden cardiac death. The majority of the literature is based on expert opinion, case reports, and retrospective data sets. The literature does support the correlation of early cardiopulmonary resuscitation and defibrillation with increased survival rates among persons experiencing sudden cardiac arrest. CONCLUSIONS Additional evidence-based research is needed to support the long-term outcomes of AED legislation and its utility in sparing the lives of student athletes. However, the evidence supporting early intervention, a coordinated emergency plan, and rapid emergency medical services response is conclusive enough to warrant state or federal legislation mandating that AEDs be present in all school gyms and athletic fields.
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Marijon E, Uy-Evanado A, Reinier K, Teodorescu C, Narayanan K, Jouven X, Gunson K, Jui J, Chugh SS. Sudden cardiac arrest during sports activity in middle age. Circulation 2015; 131:1384-91. [PMID: 25847988 DOI: 10.1161/circulationaha.114.011988] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 02/13/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Sports-associated sudden cardiac arrests (SCAs) occur mostly during middle age. We sought to determine the burden, characteristics, and outcomes of SCA during sports among middle-aged residents of a large US community. METHODS AND RESULTS Patients with SCA who were 35 to 65 years of age were identified in a large, prospective, population-based study (2002-2013), with systematic and comprehensive assessment of their lifetime medical history. Of the 1247 SCA cases, 63 (5%) occurred during sports activities at a mean age of 51.1±8.8 years, yielding an incidence of 21.7 (95% confidence interval, 8.1-35.4) per 1 million per year. The incidence varied significantly by sex, with a higher incidence among men (relative risk, 18.68; 95% confidence interval, 2.50-139.56) for sports SCAs compared with all other SCAs (relative risk 2.58; 95% confidence interval, 2.12-3.13). Sports SCA was also more likely to be a witnessed event (87% versus 53%; P<0.001) with cardiopulmonary resuscitation (44% versus 25%; P=0.001) and ventricular fibrillation (84% versus 51%; P<0.0001). Survival to hospital discharge was higher for sports-associated SCA (23.2% versus 13.6%; P=0.04). Sports SCA cases presented with known preexisting cardiac disease in 16% and ≥1 cardiovascular risk factors in 56%, and overall, 36% of cases had typical cardiovascular symptoms during the week preceding the SCA. CONCLUSIONS Sports-associated SCA in middle age represents a relatively small proportion of the overall SCA burden, reinforcing the idea of the high-benefit, low-risk nature of sports activity. Especially in light of current population aging trends, our findings emphasize that targeted education could maximize both safety and acceptance of sports activity in the older athlete.
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Affiliation(s)
- Eloi Marijon
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., A.U.-E., K.R., C.T., K.N., S.S.C.); European Georges Pompidou Hospital, Cardiology Department, and Paris Descartes University, Paris, France (E.M., X.J.); Oregon Health & Science University, Portland, OR (K.G., J.J.)
| | - Audrey Uy-Evanado
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., A.U.-E., K.R., C.T., K.N., S.S.C.); European Georges Pompidou Hospital, Cardiology Department, and Paris Descartes University, Paris, France (E.M., X.J.); Oregon Health & Science University, Portland, OR (K.G., J.J.)
| | - Kyndaron Reinier
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., A.U.-E., K.R., C.T., K.N., S.S.C.); European Georges Pompidou Hospital, Cardiology Department, and Paris Descartes University, Paris, France (E.M., X.J.); Oregon Health & Science University, Portland, OR (K.G., J.J.)
| | - Carmen Teodorescu
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., A.U.-E., K.R., C.T., K.N., S.S.C.); European Georges Pompidou Hospital, Cardiology Department, and Paris Descartes University, Paris, France (E.M., X.J.); Oregon Health & Science University, Portland, OR (K.G., J.J.)
| | - Kumar Narayanan
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., A.U.-E., K.R., C.T., K.N., S.S.C.); European Georges Pompidou Hospital, Cardiology Department, and Paris Descartes University, Paris, France (E.M., X.J.); Oregon Health & Science University, Portland, OR (K.G., J.J.)
| | - Xavier Jouven
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., A.U.-E., K.R., C.T., K.N., S.S.C.); European Georges Pompidou Hospital, Cardiology Department, and Paris Descartes University, Paris, France (E.M., X.J.); Oregon Health & Science University, Portland, OR (K.G., J.J.)
| | - Karen Gunson
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., A.U.-E., K.R., C.T., K.N., S.S.C.); European Georges Pompidou Hospital, Cardiology Department, and Paris Descartes University, Paris, France (E.M., X.J.); Oregon Health & Science University, Portland, OR (K.G., J.J.)
| | - Jonathan Jui
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., A.U.-E., K.R., C.T., K.N., S.S.C.); European Georges Pompidou Hospital, Cardiology Department, and Paris Descartes University, Paris, France (E.M., X.J.); Oregon Health & Science University, Portland, OR (K.G., J.J.)
| | - Sumeet S Chugh
- From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (E.M., A.U.-E., K.R., C.T., K.N., S.S.C.); European Georges Pompidou Hospital, Cardiology Department, and Paris Descartes University, Paris, France (E.M., X.J.); Oregon Health & Science University, Portland, OR (K.G., J.J.).
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Abstract
Screening for conditions associated with sudden cardiac arrest in the United States (US) is aimed at high school athletes in most states and utilizes a preparticipation history and physical form that is not standardized across the US. In Italy, data have shown that their incidence of sudden cardiac arrest has decreased significantly after implementation of an electrocardiographic-based screening program including history and physical exam. The American Heart Association recommendations do not include an electrocardiogram. A recent AHA statement has suggested that those screening athletes should consider all children of similar ages in the selected venue, but still should not include an electrocardiogram. A number of models of screening are presented along with a best practice recommendation for further evaluation and study.
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Affiliation(s)
- Victoria L Vetter
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
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28
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Vetter VL. Electrocardiographic screening of all infants, children, and teenagers should be performed. Circulation 2015; 130:688-97; discussion 697. [PMID: 25135125 DOI: 10.1161/circulationaha.114.009737] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Victoria L Vetter
- From The Children's Hospital of Philadelphia, and Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
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30
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Lawless CE, Asplund C, Asif IM, Courson R, Emery MS, Fuisz A, Kovacs RJ, Lawrence SM, Levine BD, Link MS, Martinez MW, Matherne GP, Olshansky B, Roberts WO, Salberg L, Vetter VL, Vogel RA, Whitehead J. Protecting the Heart of the American Athlete. J Am Coll Cardiol 2014; 64:2146-71. [DOI: 10.1016/j.jacc.2014.08.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Trojian TH, Cracco A, Hall M, Mascaro M, Aerni G, Ragle R. Basketball injuries: caring for a basketball team. Curr Sports Med Rep 2014; 12:321-8. [PMID: 24030307 DOI: 10.1097/01.csmr.0000434055.36042.cd] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Basketball is a popular sport in North America and worldwide. Most injuries are lower extremity injuries to the ankle and knee. In this article, injuries common to basketball and, from our experience, injuries that escape injury surveillance systems are discussed from the physician and athletic trainer's perspective. Both treatment and prevention of injuries are discussed.
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Affiliation(s)
- Thomas H Trojian
- Saint Francis Hospital and Medical Center, University of Connecticut Health Center, Farmington, CT
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Heidbuchel H, Carré F. Exercise and competitive sports in patients with an implantable cardioverter-defibrillator. Eur Heart J 2014; 35:3097-102. [PMID: 24713647 DOI: 10.1093/eurheartj/ehu130] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Implantable cardioverter-defibrillators (ICDs) prevent sudden arrhythmic death in patients with different arrhythmogenic cardiac diseases. Because intense physical activity may trigger ventricular arrhythmias and may favour inappropriate shock delivery that impacts quality of life, current international recommendations only give clearance for moderate leisure-time physical activity to patients with an ICD. Hence, athletes are deemed non-eligible to compete with their ICD. The rationale for the current restriction from competitive sports is discussed in this review, as well as new insights that may alter these recommendations for certain sports participants in the foreseeable future. This review provides guidance for the choice of a durable lead and device system, careful programming tailored to the characteristics of the patient's physiological and pathological heart rhythms, instalment of preventive bradycardic medication, and guided rehabilitation with psychological counselling, allowing a maximum of benefit and a minimum of harm for physically active ICD patients.
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Affiliation(s)
- Hein Heidbuchel
- Department of Cardiovascular Sciences, Arrhythmology, University of Leuven, Herestraat 49, Leuven B-3000, Belgium
| | - Francois Carré
- Rennes 1 Université, Pontchaillou Hospital, INSERM U 1099, Rennes, France
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Abstract
Hypertrophic cardiomyopathy (HCM) is an autosomal dominant, cardiovascular disorder that carries the risk of sudden cardiac death. The prevalence of HCM is 1:500 persons. The purpose of this article is to provide an overview of the pathophysiology, symptoms, complications, diagnostic testing, and treatment. The silent presentation of HCM presents unique diagnostic challenges and complicates prompt identification. Diagnostic testing and management strategies for the care of a person with HCM are discussed. HCM has individualized presentation and therefore requires individualized therapy.
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Affiliation(s)
- Kim Subasic
- Department of Nursing, University of Scranton, Linden Street, Scranton, PA 18510, USA.
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Mitani Y, Ohta K, Ichida F, Nii M, Arakaki Y, Ushinohama H, Takahashi T, Ohashi H, Yodoya N, Fujii E, Ishikura K, Tateno S, Sato S, Suzuki T, Higaki T, Iwamoto M, Yoshinaga M, Nagashima M, Sumitomo N. Circumstances and Outcomes of Out-Of-Hospital Cardiac Arrest in Elementary and Middle School Students in the Era of Public-Access Defibrillation. Circ J 2014; 78:701-7. [DOI: 10.1253/circj.cj-13-1162] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yoshihide Mitani
- Department of Pediatrics, Mie University Graduate School of Medicine
| | - Kunio Ohta
- Department of Pediatrics, Kanazawa University Graduate School of Medicine
| | - Fukiko Ichida
- Department of Pediatrics, Toyama University Graduate School of Medicine
| | - Masaki Nii
- Department of Cardiology, Sizuoka Children’s Hospital
| | | | | | | | - Hiroyuki Ohashi
- Department of Pediatrics, Mie University Graduate School of Medicine
| | - Noriko Yodoya
- Department of Pediatrics, Mie University Graduate School of Medicine
| | - Eitaro Fujii
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | - Ken Ishikura
- Emergency Critical Care Center, Mie University Graduate School of Medicine
| | | | - Seiichi Sato
- Department of Pediatrics, Niigata City General Hospital
| | - Tsugutoshi Suzuki
- Department of Pediatric Electrophysiology, Osaka City General Hospital
| | - Takashi Higaki
- Department of Pediatric Cardiology, Children’s Medical Center, Ehime University Hospital
| | - Mari Iwamoto
- Department of Pediatric Cardiology, Yokohama City University
| | - Masao Yoshinaga
- Department of Pediatrics, National Hospital Organization Kagoshima Medical Center
| | - Masami Nagashima
- Department of Pediatric Cardiology, Aichi Children’s Health and Medical Center
| | - Naokata Sumitomo
- Department of Pediatrics and Child Health, Nihon University School of Medicine
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Marijon E, Bougouin W, Celermajer DS, Périer MC, Dumas F, Benameur N, Karam N, Lamhaut L, Tafflet M, Mustafic H, de Deus NM, Le Heuzey JY, Desnos M, Avillach P, Spaulding C, Cariou A, Prugger C, Empana JP, Jouven X. Characteristics and Outcomes of Sudden Cardiac Arrest During Sports in Women. Circ Arrhythm Electrophysiol 2013; 6:1185-91. [DOI: 10.1161/circep.113.000651] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
No specific data are available on characteristics and outcome of sudden cardiac death (SCD) during sport activities among women in the general population.
Methods and Results—
From a prospective 5-year national survey, involving 820 subjects 10 to 75 years old who presented with SCD (resuscitated or not) during competitive or recreational sport activities, 43 (5.2%) such events occurred in women, principally during jogging, cycling, and swimming. The level of activity at the time of SCD was moderate to vigorous in 35 cases (81.4%). The overall incidence of sport-related SCD, among 15- to 75-year-old women, was estimated as 0.59 (95% confidence interval [CI], 0.39–0.79) to 2.17 (95% CI, 1.38–2.96) per year per million female sports participants for the 80th and 20th percentiles of reporting districts, respectively. Compared with men, the incidence of SCDs in women was dramatically lower, particularly in the 45- to 54-year range (relative risk, 0.033; 95% CI, 0.015–0.075). Despite similar circumstances of occurrence, survival at hospital admission (46.5%; 95% CI, 31.0–60.0) was significantly higher than that for men (30.0%; 95% CI, 26.8–33.2;
P
=0.02), although this did not reach statistical significance for hospital discharge. Favorable neurological outcomes were similar (80%). Cause of death seemed less likely to be associated with structural heart disease in women compared with men (58.3% versus 95.8%;
P
=0.003).
Conclusions—
Sports-related SCDs in women participants seems dramatically less common (up to 30-fold less frequent) compared with men. Our results also suggest a higher likelihood of successful resuscitation as well as less frequency of structural heart disease in women compared with men.
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Affiliation(s)
- Eloi Marijon
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Wulfran Bougouin
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - David S. Celermajer
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Marie-Cécile Périer
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Florence Dumas
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Nordine Benameur
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Nicole Karam
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Lionel Lamhaut
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Muriel Tafflet
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Hazrije Mustafic
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Natalia Machado de Deus
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Jean-Yves Le Heuzey
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Michel Desnos
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Paul Avillach
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Christian Spaulding
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Alain Cariou
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Christof Prugger
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Jean-Philippe Empana
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
| | - Xavier Jouven
- From the Paris Cardiovascular Research Center, Inserm Unit 970, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., C.S., A.C., C.P., J.-P.E., X.J.); Paris Descartes University, Paris, France (E.M., W.B., M.-C.P., F.D., N.K., L.L., M.T., H.M., J.-Y.L.H., M.D., P.A., C.S., A.C., C.P., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (E.M., N.K., J.-Y.L.H., M.D., C.S., X.J.); Medical Intensive Care Unit, Cochin Hospital, Paris, France (W.B., A.C.)
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Drezner JA, Toresdahl BG, Rao AL, Huszti E, Harmon KG. Outcomes from sudden cardiac arrest in US high schools: a 2-year prospective study from the National Registry for AED Use in Sports. Br J Sports Med 2013; 47:1179-83. [DOI: 10.1136/bjsports-2013-092786] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Marijon E, Bougouin W, Celermajer DS, Perier MC, Benameur N, Lamhaut L, Karam N, Dumas F, Tafflet M, Prugger C, Mustafic H, Rifler JP, Desnos M, Le Heuzey JY, Spaulding CM, Avillach P, Cariou A, Empana JP, Jouven X. Major regional disparities in outcomes after sudden cardiac arrest during sports. Eur Heart J 2013; 34:3632-40. [DOI: 10.1093/eurheartj/eht282] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Schmied C, Drezner J, Kramer E, Dvorak J. Cardiac events in football and strategies for first-responder treatment on the field. Br J Sports Med 2013; 47:1175-8. [DOI: 10.1136/bjsports-2012-091918] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Sudden cardiac death is a rare but socially devastating event. The most common causes of sudden cardiac death are congenital electrical disorders and structural heart diseases. The majority of these diseases have an incomplete penetrance and variable expression; therefore, patients may be unaware of their illness. In several cases, physical activity can be the trigger for sudden cardiac death as first symptom. Our purpose is to review the causes of sudden cardiac death in sportive children and young adults and its genetic background. Symptomatic individuals often receive an implantable cardioverter-defibrillator, the preventive treatment for sudden cardiac death in most of cases due to channelopathies, which can become a challenging option in young and active patients. The identification of one of these diseases in asymptomatic patients has similarly a great impact on their everyday life, especially on their ability to undertake competitive physical activities, and the requirement of prophylactic treatment. We review main causes of sudden cardiac death in relation to its genetics and diagnostic work-up
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Dougherty KR, Friedman RA, Link MS, Estes NAM. Prediction and prevention of sudden death in young populations: the role of ECG screening. J Interv Card Electrophysiol 2012. [DOI: 10.1007/s10840-012-9755-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McDonough A, Callan K, Egizio K, Kenney K, Gray G, Mundry G, Re G. Student perceptions of sudden cardiac arrest: a qualitative inquiry. ACTA ACUST UNITED AC 2012; 21:523-7. [DOI: 10.12968/bjon.2012.21.9.523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Estes NAM, Link MS. Preparticipation athletic screening including an electrocardiogram: an unproven strategy for prevention of sudden cardiac death in the athlete. Prog Cardiovasc Dis 2012; 54:451-4. [PMID: 22386297 DOI: 10.1016/j.pcad.2012.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
One of the fundamental principles of evidence-based medicine is that clinical practice should be based on evidence derived from sufficiently robust data to ensure that the benefits, risks, and costs of an intervention are known. Although intuitively appealing, athletic screening programs with routine electrocardiograms (ECGs) followed by restriction of at-risk individuals have not been demonstrated to be effective in decreasing the inherent risk of athletic sudden death. The incremental use of a screening ECG to a history and physical examination remains debatable because of insufficient evidence to conclusively resolve the issue. Long-term outcomes with a large group of athletes undergoing screening and restriction are limited to a small number of observational trials. One supports and many do not support ECG screening with athletic restriction of at-risk athletes. Although programs and policies to decrease sudden death are laudable, they need further evaluation before being implemented on a large-scale basis. Currently, athletes are best protected by a strategy of secondary prevention with improvements in resuscitation and emergency action plans.
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Affiliation(s)
- N A Mark Estes
- Department of Medicine, New England Cardiac Arrhythmia Center, The Tufts Cardiovascular Center, Tufts University School of Medicine, Boston, MA 02111, USA.
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46
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Kovach J, Berger S. Automated external defibrillators and secondary prevention of sudden cardiac death among children and adolescents. Pediatr Cardiol 2012; 33:402-6. [PMID: 22302278 DOI: 10.1007/s00246-012-0158-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 08/16/2011] [Indexed: 11/30/2022]
Abstract
Sudden cardiac death is devastating at any age, but it is especially so among children and adolescents. This report discusses the outcomes for patients with out-of hospital cardiac arrest (OHCA) and describes public access defibrillation programs in general and those directed at children and adolescents. In addition, the relatively new concept of cardiopulmonary resuscitation (CPR)–automated external defibrillator (AED) programs directed at schools is discussed. Although limited data are available, some of the preliminary data suggest improved OHCA outcomes associated with CPR-AED programs implemented in schools. These early data provide hope for the future potential reduction in the incidence of sudden cardiac deaths in the school setting, not only among children and adolescents, but also among adults.
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Affiliation(s)
- Joshua Kovach
- The Herma Heart Center, Children’s Hospital of Wisconsin, The Medical College of Wisconsin, 9000 W. Wisconsin Ave, MS 713, Milwaukee, WI 53226, USA.
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Abstract
Sudden cardiac death is the leading cause of nontraumatic mortality in young athletes. The estimated incidence varies; however, recent studies have provided more accurate data. Most cases are attributed to silent hereditary or congenital cardiac disorders, many of which may be detected through preparticipation screening programs. This article provides a comprehensive review of the incidence and etiology of sudden cardiac death in young athletes, with practical advice regarding evaluation and management in light of a large number of recent advances. A brief outline of current perspectives on preparticipation screening programs and prevention is included.
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Affiliation(s)
- Nabeel Sheikh
- Department of Cardiovascular Sciences, St. George's University of London, London, UK
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Marijon E, Tafflet M, Celermajer DS, Dumas F, Perier MC, Mustafic H, Toussaint JF, Desnos M, Rieu M, Benameur N, Le Heuzey JY, Empana JP, Jouven X. Sports-related sudden death in the general population. Circulation 2011; 124:672-81. [PMID: 21788587 DOI: 10.1161/circulationaha.110.008979] [Citation(s) in RCA: 312] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although such data are available for young competitive athletes, the prevalence, characteristics, and outcome of sports-related sudden death have not been assessed previously in the general population. METHODS AND RESULTS A prospective and comprehensive national survey was performed throughout France from 2005 to 2010, involving subjects 10 to 75 years of age. Case detection for sports-related sudden death, including resuscitated cardiac arrest, was undertaken via national ambulance service reporting and Web-based screening of media releases. The overall burden of sports-related sudden death was 4.6 cases per million population per year, with 6% of cases occurring in young competitive athletes. Sensitivity analyses used to address suspected underreporting demonstrated an incidence ranging from 5 to 17 new cases per million population per year. More than 90% of cases occurred in the context of recreational sports. The age of subjects was relatively young (mean ± SD 46 ± 15 years), with a predominance of men (95%). Although most cases were witnessed (93%), bystander cardiopulmonary resuscitation was only commenced in 30.7% of cases. Bystander cardiopulmonary resuscitation (odds ratio 3.73, 95% confidence interval 2.19 to 6.39, P<0.0001) and initial use of cardiac defibrillation (odds ratio 3.71, 95% confidence interval 2.07 to 6.64, P<0.0001) were the strongest independent predictors for survival to hospital discharge (15.7%, 95% confidence interval 13.2% to 18.2%). CONCLUSIONS Sports-related sudden death in the general population is considerably more common than previously suspected. Most cases are witnessed, yet bystander cardiopulmonary resuscitation was only initiated in one third of cases. Given the often predictable setting of sports-related sudden death and that prompt interventions were significantly associated with improved survival, these data have implications for health services planning.
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Affiliation(s)
- Eloi Marijon
- Paris Cardiovascular Research Center, INSERM U970, Hôpital européen Georges Pompidou, Paris CEDEX 15, France.
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Harmon KG, Asif IM, Klossner D, Drezner JA. Incidence of sudden cardiac death in National Collegiate Athletic Association athletes. Circulation 2011; 123:1594-600. [PMID: 21464047 DOI: 10.1161/circulationaha.110.004622] [Citation(s) in RCA: 353] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The true incidence of sudden cardiac death (SCD) in US athletes is unknown. Current estimates are based largely on case identification through public media reports and estimated participation rates. The purpose of this study was to more precisely estimate the incidence of SCD in National Collegiate Athletic Association (NCAA) student-athletes and assess the accuracy of traditional methods for collecting data on SCD. METHODS AND RESULTS From January 2004 through December 2008, all cases of sudden death in NCAA student-athletes were identified by use of an NCAA database, weekly systematic search of public media reports, and catastrophic insurance claims. During the 5-year period, there were 273 deaths and a total of 1 969 663 athlete participant-years. Of these 273 deaths, 187 (68%) were due to nonmedical or traumatic causes, 80 (29%) to medical causes, and 6 (2%) to unknown causes. Cardiovascular-related sudden death was the leading cause of death in 45 (56%) of 80 medical cases, and represented 75% of sudden deaths during exertion. The incidence of SCD was 1:43 770 participants per year. Among NCAA Division I male basketball players, the rate of SCD was 1:3100 per year. Thirty-nine (87%) of the 45 cardiac cases were identified in the NCAA database, only 25 (56%) by use of public media reports, and 9 (20%) from catastrophic claims data. CONCLUSIONS SCD is the leading medical cause of death and death during exercise in NCAA student-athletes. Current methods of data collection underestimate the risk of SCD. Accurate assessment of SCD incidence is necessary to shape appropriate health policy decisions and develop effective strategies for prevention.
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Affiliation(s)
- Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, USA.
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