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Canadian Journal of Cardiology

Sports-Related Sudden Cardiac Arrest in Germany

Published:March 23, 2020DOI:https://doi.org/10.1016/j.cjca.2020.03.021

      Abstract

      Background

      Knowledge about causes of sports-related sudden cardiac arrest (SrSCA) may influence national strategies to prevent such events. Therefore, we established a prospective registry on SrSCA to estimate the incidence and in particular describe the etiologies of SrSCA in the general population in Germany.

      Methods

      The registration of SrSCA based upon 4 pillars: a web-based platform to record SrSCA cases in competitive and recreational athletes, media-monitoring, cooperation with the German Resuscitation Registry, and 15 institutes of forensic medicine.

      Results

      After an observation period of 6 years, a total of 349 cases was recorded (mean age 48.0 ± 12.7 years); 109 subjects survived. Most of the cases occurred during nonelite competitive or recreational sports. Bystander cardiopulmonary resuscitation (CPR) was initiated in 262 cases (75%); however, rhythm analysis and defibrillation (if indicated) was mainly performed by medical services. In patients ≤ 35 years of age, premature coronary artery disease (CAD) and sudden arrhythmic death syndrome (SADS) prevailed, followed by myocarditis. In athletes ≥ 35 years of age, CAD predominated.

      Conclusions

      Country-specific registries are necessary to define the national screening and prevention strategy optimally. In Germany, premature CAD, SADS, and myocarditis are the leading causes of SrSCA in young athletes, reinforcing the great disparity of the prevalence of cardiac diseases among different countries. Extension of on-site SCD-prevention campaigns, with training of CPR and explanation of the efficient use of automated external defibrillators (AEDs), may decrease the burden of SrSCD.

      Résumé

      Contexte

      La connaissance des causes de l’arrêt cardiaque soudain lié à la pratique sportive (ACSs) pourrait éclairer les stratégies nationales visant à prévenir la survenue de tels événements. Nous avons donc constitué un registre prospectif des ACSs afin d’estimer l’incidence des ACSs et, plus particulièrement, d’en décrire les causes dans la population générale en Allemagne.

      Méthodologie

      Le registre des ACSs repose sur quatre sources de données principales : 1) une plateforme Web pour le signalement des cas d’ACSs survenus chez des athlètes de compétition ou des sportifs occasionnels; 2) la surveillance des médias; 3) une collaboration avec le German Resuscitation Registry (registre allemand des réanimations); et 4) une collaboration avec 15 établissements médico-légaux.

      Résultats

      Après 6 années d’observation, un nombre total de 349 cas ont été répertoriés (âge moyen : 48,0 ± 12,7 ans), parmi lesquels 109 sujets ont survécu. La plupart des cas sont survenus dans le cadre de compétitions ou d’activités sportives de niveau amateur. La réanimation cardiorespiratoire (RCR) a été amorcée par un témoin dans 262 cas (75 %), mais l’analyse du rythme cardiaque et la défibrillation (si elle était indiquée) ont été effectuées principalement par du personnel médical. Chez les sujets de 35 ans ou moins, les causes prédominantes étaient la coronaropathie prématurée et le syndrome de la mort subite par arythmie (SMSA), suivis de la myocardite. Chez les athlétes de plus de 35 ans, la coronaropathie était plus fréquente.

      Conclusions

      Pour définir de manière optimale les stratégies nationales de dépistage et de prévention, chaque pays doit établir son propre registre. En Allemagne, la coronaropathie prématurée, le SMSA et la myocardite sont les principales causes d’ACSs chez les jeunes athlètes, ce qui vient confirmer la grande disparité observée dans différents pays quant à la prévalence des maladies cardiaques. L’intensification de campagnes de prévention de la mort cardiaque subite sur place lors des événements sportifs, jumelée à une formation en RCR et sur l’utilisation efficiente d’un défibrillateur externe automatisé (DEA), pourrait contribuer à réduire le fardeau de l’ACSs.
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