Why athletes have sudden cardiac arrests - doctors' explanation

Sudden cardiac arrest in athletes is a rare but extremely dangerous event that most often occurs during competition and training. New data show that such episodes are often the first manifestation of previously undiagnosed heart disease. This is stated in a review by the Yale School of Medicine, published in the New England Journal of Medicine.

According to the authors, including cardiologist Rachel Lampert, sudden cardiac arrest most often occurs against the background of intense physical activity. The main causes are inherited structural heart diseases such as hypertrophic cardiomyopathy, electrical conduction disorders - such as prolonged QT syndrome - and congenital anomalies.

The danger is that many of these conditions can be asymptomatic and go undetected without a targeted examination. As a result, cardiac arrest becomes the first and most dramatic sign of disease.

The review emphasises the importance of prevention. Primary prevention includes the detection of latent heart disease before an athlete takes to the starting line. One of the key tools here is electrocardiography (ECG), which is now used by about half of US National Collegiate Athletic Association programmes. At Yale University, ECG is part of the standard procedure for athletes to be cleared for competition.

However, the authors note that an ECG alone is not enough - the results require competent interpretation by specialists and follow-up medical monitoring if necessary.

Secondary prevention - actions at the moment of cardiac arrest - is equally important. This involves a well-developed emergency response plan, including immediate initiation of cardiopulmonary resuscitation, use of automated external defibrillators and coordination of further medical care.

The review pays particular attention to the issue of athletes returning to competition following the diagnosis of cardiac disease. Previously, such diagnoses often meant an automatic ban on continuing a career. However, current research shows that with proper treatment and monitoring, some athletes can safely return to training.

The authors emphasise the importance of shared decision-making that balances medical advice with the athlete's own values, goals and risk tolerance. This approach moves away from rigid prohibitions and towards an individualised assessment of the situation.

According to the researchers, the review helps to systematise disparate data and highlight gaps in knowledge, particularly in relation to rare inherited heart conditions. Further research is needed to improve diagnostic protocols and the eligibility of athletes to compete.