Sudden Cardiac Arrest and Death in Sports: An Updated Overview of Epidemiology, Etiologies, and Prevention Strategies, with Emphasis on Inherited Cardiomyopathies

Sudden cardiac arrest (SCA) and sudden cardiac death (SCD) in sports, although rare, remain pressing concerns with rising global participation in athletics. Recent epidemiological analyses indicate that incidence of SCA/SCD in athletes is low and has remained relatively stable over the past two decades. However, outcomes have improved as survival rates increase, reflecting advances in emergency response. Key risk factors are well-established, such as male athletes face a markedly higher risk than females, older master athletes have higher SCD risk rates than those under 35 years (largely due to acquired coronary artery disease), and certain high-intensity sports (e.g., basketball, American football, soccer, and endurance exercise) present higher SCA/SCD risk. In young competitive athletes, most SCDs are a consequence of undetected hereditary or congenital heart disorders. Predominant causes in this group include structural cardiomyopathies, such as hypertrophic cardiomyopathy and arrhythmogenic cardiomyopathy, and primary electrical diseases (channelopathies like long QT syndrome, Brugada syndrome, or catecholaminergic polymorphic ventricular tachycardia). Contrarily, occult atherosclerotic coronary disease becomes the leading cause of fatal events in master athletes. Multifaceted prevention strategies have expanded in recent years. Pre-participation cardiac screening programs aim to detect at-risk individuals and have successfully prevented SCD. Equally important, widespread implementation of emergency action plans, including on-site automated external defibrillators and cardiopulmonary resuscitation training, has improved resuscitation outcomes. Heightened public awareness, prompted by high-profile on-field cardiac arrests, has catalyzed policy changes that mandate better cardiac screening and emergency preparedness. Collectively, these efforts are shaping a safer sporting environment and reducing the SCA/SCD risk in athletes.