Incidence of sudden cardiac arrest and death in young athletes and military members: a systematic review and meta-analysis.
incidence; sudden cardiac death; military; athletes; sudden cardiac arrest
OBJECTIVES: The goals of this review are to evaluate the quality of the evidence on the incidence of sudden cardiac arrest and death (SCA/D) in athletes and military members; and to estimate annual incidence of SCA/D. DATA SOURCES: MEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORT discus, PEDro, and clinicaltrials.gov were searched from inception to dates between 2/21/19-7/29/19. STUDY SELECTION: Studies which reported incidence of SCA/D or both in athletes, or military members under age 40 were eligible for inclusion. 40 studies were identified for inclusion Data Extraction: Risk of bias was assessed using a validated, customized tool for prevalence studies in all included studies. 12 were found to be low ROB, with the remaining 28 moderate or high ROB. Data was extracted for narrative review, and meta-analysis. DATA SYNTHESIS: Random-effects meta-analysis was performed in studies judged to be low risk of bias in two separate categories: 5 studies on regional or national level data including athletes at all levels, and both sexes included 130 events of SCD, with a total of 11,272,560 athlete years showing a cumulative incidence rate of 0.98 [95%CI: 0.62, 1.53] per 100,000 athlete years, with high heterogeneity with I2 of 78%; 3 Studies on competitive athletes aged 14 to 25 were combined, and included 183 events, and 17,798758 athlete years showing an incidence rate of 1.91[95%CI: 0.71; 5.14] per 100,000 athlete years with high heterogeneity with I2 of 97%. The remaining low risk of bias studies were in military members, and were not synthesized. CONCLUSION: The worldwide incidence of SCD is a rare event. Low risk of bias studies indicate incidence to be below 2 per 100,000 athlete years. Overall, the quality of the evidence available is low, but there are high quality individual studies to inform the question of incidence levels. PROSPERO Registration: CRD42019125560.
Lear A; Patel N; Mullen C; Simonson M; Leone V; Koshiaris C; Nunan D
Journal Of Athletic Training
2021
2021-05-26
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.4085/1062-6050-0748.20" target="_blank" rel="noreferrer noopener">10.4085/1062-6050-0748.20</a>
Incidence of sudden cardiac arrest and death in young athletes and military members: a systematic review and meta-analysis.
MEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORT discus, PEDro, and clinicaltrials.gov were searched from inception to dates between 2/21/19–7/29/19.
The goals of this review are to evaluate the quality of the evidence on the incidence of sudden cardiac arrest and death (SCA/D) in athletes and military members; and to estimate annual incidence of SCA/D.
Lear A; Patel N; Mullen C; Simonson M; Leone V; Koshiaris C; Nunan D
Journal Of Athletic Training
2021
2021-05-26
Journal Article
<table width="91" style="border-collapse:collapse;width:68pt;"><colgroup><col width="91" style="width:68pt;" /></colgroup><tbody><tr style="height:15pt;"><td width="91" height="20" class="xl18" style="width:68pt;height:15pt;"><a href="http://doi.org/10.4085/1062-6050-0748.20">http://doi.org/10.4085/1062-6050-0748.20</a></td>
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Screening Electrocardiogram in Young Athletes and Military Members: A Systematic Review and Meta-Analysis
Objective: To determine the effect of electrocardiogram (ECG) screening on the prevention of sudden cardiac arrest and death in young athletes and military members.
Data sources: MEDLINE, Embase, CENTRAL, Web of Science, BIOSIS, Scopus, SPORTDiscus, PEDro, and ClinicalTrials.gov were searched from inception to dates between February 21 and July 29, 2019.
Study selection: Randomized and nonrandomized controlled trials in which preparticipation examination including ECG was the primary intervention used to screen athletes or military members aged ≤40 years. Acceptable control groups were those receiving no screening, usual care, or preparticipation examination without ECG. Three published studies and 1 conference abstract were identified for inclusion.
Data extraction: In all 4 studies, risk of bias was assessed using the Cochrane risk-of-bias tool and was found to be generally high. Two studies had data extracted for random effects meta-analysis, and the remaining study and conference abstract were included in the narrative review. The overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach.
Data synthesis: We included 4 nonrandomized studies (11 689 172 participants), of which all had a high risk of bias. Pooled data from 2 studies (n = 3 869 274; very low-quality evidence) showed an inconclusive 42% relative decrease in risk of sudden cardiac death (relative risk = 0.58; 95% CI = 0.23, 1.45), equating to an absolute risk reduction of 0.0016%. The findings were consistent with a potential 77% relative decreased risk to a 45% relative increased risk in participants screened using ECG. Heterogeneity was found to be high, as measured using I2 statistic (71%). Data from the remaining study and abstract were similarly inconclusive.
Conclusions: Existing evidence for the effect of ECG screening is inconclusive and of very low quality. In our meta-analysis, we observed that screening ECG may result in a considerable benefit or harm to participants. Higher-quality studies are needed to reduce this uncertainty.
Aaron Lear
Niraj Patel
Chanda Mullen
Marian Simonson
Vince Leone
Constantinos Koshiaris
David Nunan
J Athl Train
. 2022 May 1;57(5):444-451. doi: 10.4085/1062-6050-0746.20.
2022
English
Screening electrocardiogram in young athletes and military members: a systematic review and meta-analysis.
sudden cardiac death; athlete; military; sudden cardiac arrest; electrocardiogram screening
OBJECTIVE: To determine the effect of electrocardiogram (ECG) screening on prevention of sudden cardiac arrest and death (SCA/D) in young athletes and military members. DATA SOURCES: MEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORT discus, PEDro, and clinicaltrials.gov were searched from inception to dates between 2/21/19 and 7/29/19. STUDY SELECTION: Randomized and non-randomized controlled trials, where pre-participation examination including ECG was the primary intervention used to screen athletes or military 40 years of age or younger. Accepted controls were no screening, usual care, or pre-participation examination without ECG. 3 published studies , and one conference abstract were identified for inclusion. DATA EXTRACTION: In all four studies, risk of bias was assessed with the Cochrane risk of bias tool, and found to be generally high. Two studies had data extracted for random effects meta-analysis, and the remaining study and conference abstract were included in narrative review. Overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Data Synthesis: Four non-randomized studies (11,689,172 participants) were included, all at high risk of bias. Pooled data from two studies (n= 3,869,274; very low quality evidence) observed an inconclusive 42% relative decrease in risk of sudden cardiac death (RR 0.58; 95% CI 0.23, 1.45), equating to an absolute risk reduction of .0016% The findings were consistent with a potential 67% relative decrease to a 45% relative increased risk in participants screened with ECG. Heterogeneity was found to be high as measured with I2 statistic (71%). Data from the remaining study and abstract were similarly inconclusive. CONCLUSION: Existing evidence for the effect of ECG screening is inconclusive and of very low quality. Our meta-analysis observed that screening ECG may result in considerable benefit or harm to participants. Higher quality studies are needed to reduce this uncertainty. PROSPERO Registration: CRD42019125560.
Lear A; Patel N; Mullen C; Simonson M; Leone V; Koshiaris C; Nunan D
Journal Of Athletic Training
2021
2021-05-26
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.4085/1062-6050-0746.20" target="_blank" rel="noreferrer noopener">10.4085/1062-6050-0746.20</a>
Screening electrocardiogram in young athletes and military members: a systematic review and meta-analysis.
Randomized and non-randomized controlled trials, where pre-participation examination including ECG was the primary intervention used to screen athletes or military 40 years of age or younger. Accepted controls were no screening, usual care, or pre-participation examination without ECG. 3 published studies , and one conference abstract were identified for inclusion.
To determine the effect of electrocardiogram (ECG) screening on prevention of sudden cardiac arrest and death (SCA/D) in young athletes and military members.
Lear A; Patel N; Mullen C; Simonson M; Leone V; Koshiaris C; Nunan D
Journal Of Athletic Training
2021
2021-05-26
Journal Article
<table width="91" style="border-collapse:collapse;width:68pt;"><colgroup><col width="91" style="width:68pt;" /></colgroup><tbody><tr style="height:15pt;"><td width="91" height="20" class="xl18" style="width:68pt;height:15pt;"><a href="http://doi.org/10.4085/1062-6050-0746.20">http://doi.org/10.4085/1062-6050-0746.20</a></td>
</tr></tbody></table>
Type 1 Brugada Pattern Associated with Nicotine Toxicity.
Adult; Adverse Drug Event; Behavior Rating Scales; Brugada pattern; Brugada syndrome; Brugada Syndrome – Chemically Induced; Brugada Syndrome – Diagnosis; Brugada Syndrome – Therapy; Brugada Syndrome/*chemically induced/*diagnosis/therapy; cardiac sodium channels; Drug-Related Side Effects and Adverse Reactions; electrocardiogram; Electrocardiography; Female; Humans; implanted cardioverter defibrillator; Nicotine; nicotine toxicity; Nicotine/*toxicity; sudden cardiac death; Tobacco Use Cessation Devices/*adverse effects; Tobacco Use Cessation Products – Adverse Effects
BACKGROUND: Brugada pattern (BrP) findings on electrocardiogram (ECG) are mandatory for the diagnosis of Brugada syndrome (BrS). BrS is an incompletely understood cause of sudden cardiac death. CASE REPORT: Our patient was a young woman who was using topical nicotine for assistance in smoking cessation at a relatively high dose compared to her daily cigarette intake. She presented with symptoms of mild nicotine toxicity and had an ECG with a type 1 BrP. An ECG the next day was normal and electrophysiology consultation was conducted. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Recognition of a BrP ECG by emergency physicians is critical because this is the first step in diagnosing BrS, a condition that is characterized by ventricular dysrhythmias and sudden cardiac death. In addition, ECG abnormalities can be transient in nature, requiring vigilance by the emergency physician to prevent the patients' potential life threat from going undiagnosed. We present the first case to our knowledge of a BrP associated with nicotine toxicity. We also discuss treatment and disposition recommendations.
Ondrejka Jason; Giorgio Gary
The Journal of emergency medicine
2015
2015-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jemermed.2015.08.008" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2015.08.008</a>