Sudden Death in Young Athletes

This is an event no one wants to see, a sudden death of a young person.

I am Medical Director of Ambulance services, and last summer before school we did EKGs because we can, for free for all the kids locally who needed athletic physicals.
The rate of abnormal EKGs in our screen was low. I am ambivalent about doing EKGs, but for athletes finding an abnormal could be helpful in preventing arrythmia that might be fatal.
This report on studies regarding the subject does not promote the idea. Commentary is provided by Dr. Maron, lead Author of the study.
Sudden Death in US College Athletes
J Am Coll Cardiol 2014 Feb 26;[EPub Ahead of Print], BJ Maron, TS Haas, CJ Murphy, A Ahluwalia, S Rutten-Ramos
Research · March 06, 2014
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The researchers assessed databases of college athletes. Over a 10-year period, of 182 sudden deaths, 31 were due to suicide, 21 were due to drug abuse, and 64 were probably or likely attributable to cardiovascular causes. The risk of cardiovascular deaths was fivefold more common in African-American athletes than in whites but was comparable among athletes vs the general population.
The risk of cardiac sudden death among American athletes is relatively low. Screening via 12-lead ECG prior to sports participation is not likely to have detected the majority.
Commentary by
Barry J Maron MD
Public health issues surrounding sudden deaths in young athletes and strategies for identification of at-risk individuals by preparticipation screening have in recent years emerged and triggered a highly visible and sometimes contentious debate. Proponents of screening have even argued strongly and persistently for a nationwide mandatory screening program, including routine ECGs for all athletes in the US and elsewhere. Fortunately, a large measure of clarification regarding this discussion comes from three recent and timely publications in the cardiovascular literature. In one study, by Maron and colleagues in the Journal of the American College of Cardiology (JACC),1 an expansive study of more than 4 million college (NCAA) athletes over 10 years shows that risk for sudden death due to forensically proven cardiovascular diseases such as hypertrophic cardiomyopathy is relatively low—about 1/100,000 athlete-participation years, with 4 deaths occurring annually. These data are consistent with a vast and accumulating literature from cardiology investigators, which accurately characterize these tragic occurrences in young people as a low–event rate phenomenon.
The new NCAA data are important for three additional reasons:
First, the low incidence is in sharp contrast with data previously reported in such athletes from the family practice community, which did not provide the causes of death documented by autopsy (or clinically), thereby appearing to overestimate the number of cardiovascular deaths and exaggerating the true risk by about twofold.
Second, it is apparent that most cardiac deaths in college athletes are not likely to be preventable, nor can the responsible diseases be identified by preparticipation screening, even with ECGs.
Finally, the mortality rate from cardiovascular disease does not differ from that due to suicide and drug abuse, suggesting that greater focus and energy devoted to prevention in these areas, as well as wider dissemination of automated external defibrillators, will best serve the public health of college-student athletes.
Particularly relevant to the issue of cardiovascular screening in general populations of young people is the robust paper from the UK by Chandra and colleagues, also published in JACC,2 reporting on ECG screening in almost 12,000 young athletes and non-athletes. The authors found that fully 20% of non-athletes in a general population (and only one-third of athletes) had, in fact, ECG patterns judged to be pathologic by established European Society of Cardiology criteria. As the authors underscore, their data offer a paradigm shift in our perceptions of the practicality and effectiveness of ECG screening in general populations of healthy young people. There are significant limitations to the feasibility and cost-effectiveness of any nationwide screening program to detect cardiovascular disease in athletes and non-athletes alike.
The third paper by Harmon and colleagues in Circulation Arrhythmia and Electrophysiology3 appears to be an addendum (with forensic data) to a prior survey of sudden deaths in college athletes from a family practice group involved in preparticipation screening, arguing that standardized protocols for cardiovascular autopsies would be advantageous. This is a proposal about which we can certainly all agree.
References
Maron BJ, Hass TS, Murphy CJ, et al. Incidence and Causes of Sudden Death in US College Athletes [published online ahead of print February 26, 2014]. J Am Coll Cardiol. doi:10.1016/j.jacc.2014.01.041.
Chandra N, Bastiaenen R, Papadakis M, et al. The Prevalence of ECG Anomalies in Young Individuals; Relevance to a Nationwide Cardiac Screening Program [published online ahead of print February 26, 2014]. J Am Coll Cardiol. doi:10.1016/j.jacc.2014.01.046.
Harmon KG, Drezner JA, Maleszewski JJ, et al. Etiologies of Sudden Cardiac Death in National Collegiate Athletic Association Athletes [published online ahead of print March 1, 2014]. Circ Arrhythm Electrophysiol. doi: 10.1161/​CIRCEP.113.001376.