Sudden cardiac arrest and sudden cardiac death in athletes: an updated perspective

Sudden cardiac arrest (SCA) and sudden cardiac death (SCD) in athletes are rare but catastrophic events that generate substantial medical, ethical, and public health concern. Although regular physical activity is associated with significant cardiovascular benefits, intense training and competition may unmask underlying structural or electrical heart diseases in susceptible individuals. The most common causes of SCA and SCD in young athletes include hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, left ventricular hypertrophy, myocarditis, congenital coronary artery anomalies, and primary electrical disorders such as long QT syndrome. In athletes over 35 years of age, asymptomatic atherosclerotic cardiovascular disease predominates. Pre-participation cardiovascular screening, including medical history, physical examination, and, in some regions, electrocardiography (ECG) aims to identify individuals at risk. However, controversy persists regarding the sensitivity, specificity, cost-effectiveness, and potential for false-positive findings associated with screening strategies. Rapid recognition of SCA, immediate cardiopulmonary resuscitation, and early defibrillation with automated external defibrillators (AEDs) remain critical determinants of survival. The aim of this review is to summarize current evidence on the epidemiology, risk stratification, screening strategies, and emergency management of SCA and SCD in athletes and to highlight ongoing challenges and areas for future research.