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Canadian Journal of Cardiology

Sports-Related Sudden Cardiac Death Attributable to Myocarditis: A Systematic Review and Meta-analysis

      Abstract

      Background

      The incidence of sports-related sudden cardiac death (SrSCD) attributable to myocarditis is unknown. With the known association between SARS-CoV-2 (COVID-19) and myocarditis, an understanding of pre-pandemic rates of SrSCD due to myocarditis will be important in assessing a change of risk in the future. The objective was to ascertain the incidence of SrSCD or aborted sudden cardiac death (SCD) attributable to myocarditis in the general population.

      Methods

      A literature search through PubMed/Medline and Ovid/Embase was completed. Studies of SrSCD with autopsy data or clear-cause-aborted SrSCD were included. SrSCD was defined as SCD which occurred within 1 hour of exercise. Data were abstracted by 2 independent reviewers using the MOOSE guidelines. Risk assessment was performed with the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Random effects models were used to report the incidence and 95% CIs. The primary outcome was the incidence of SrSCD attributable to myocarditis, and the secondary outcome was SrSCD overall.

      Results

      Fifteen studies were included comprising 347,092,437 person-years (PY). There were 1955 SrSCD or aborted SrSCD overall with an incidence of 0.93 (95% CI 0.47-1.82) per 100,000 PY. Fifty-three SrSCD were attributed to myocarditis with an incidence of 0.047 (95% CI 0.018-0.123) per 100,000 PY, or 1 death attributable to myocarditis in 2.13 million PY.

      Conclusions

      In this meta-analysis, the overall incidence of SrSCD was low. Furthermore, SrSCD attributed to myocarditis is exceedingly rare.

      Résumé

      Contexte

      L’incidence de l’arrêt cardiaque subit lié à la pratique sportive (ACSs) et attribuable à une myocardite reste inconnue. Au vu de l’association connue entre le SARS-CoV-2 (COVID-19) et la myocardite, il serait important de connaître le taux prépandémique d’ACSs attribuables à une myocardite pour évaluer l’évolution du risque. L’objectif était de vérifier l’incidence de l’ACSs ou de l’arrêt cardiaque subit (ACS) avorté attribuable à une myocardite dans la population générale.

      Méthodologie

      Une recherche documentaire dans PubMed/Medline et Ovid/Embase a été réalisée. Elle comprenait les études portant sur les ACSs et leurs rapports d’autopsie ou les ACS avortés et de cause évidente. L’ACSs y était défini comme un ACS survenant dans la première heure d’une activité physique. Deux examinateurs indépendants ont recueilli les données selon les lignes directrices MOOSE. Une évaluation du risque a été réalisée à partir de la liste de vérification du Joanna Briggs Institute pour l’évaluation critique des études sur la prévalence. Des modèles à effets aléatoires ont servi à calculer l’incidence et les intervalles de confiance (IC) à 95 %. L’incidence de l’ACSs attribuable à une myocardite constituait le critère principal et l’ACS en général, le critère secondaire.

      Résultats

      L’analyse portait sur quinze études regroupant 347 092 437 années-personnes (AP). Elle a permis de recenser un total de 1 955 ACSs ou ACS avortés, soit une incidence de 0,93 (IC à 95 %; 0,47-1,82) pour 100 000 AP. Cinquante-trois ACSs ont été attribués à une myocardite, soit une incidence de 0,047 (IC à 95 %; 0,018-0,123) pour 100 000 AP, ce qui représente une mort attribuable à la myocardite pour 2,13 millions d’AP.

      Conclusions

      Il ressort de cette méta-analyse que l’incidence de l’ACSs est faible. De plus, les cas d’ACSs attribuables à une myocardite sont extrêmement rares.
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