SUDDEN CARDIAC DEATH IN PEDIATRIC ATHLETES: MODERN STRATEGIES FOR RISK STRATIFICATION AND SPORTS ELIGIBILITY

Highlights

• Sudden cardiac death (SCD) in children and adolescents engaged in sports is a rare but serious event that demands special attention from both medical and athletic communities. The main causes of SCD include cardiomyopathies, coronary artery anomalies, channelopathies, congenital heart defects, and aortopathies. Physical exertion can trigger fatal arrhythmias, especially in predisposed individuals.
• Modern approaches emphasize individualized risk assessment using ECG, stress testing, cardiac imaging, and, when necessary, genetic testing. Instead of strict restrictions, a shared decision-making model is promoted, taking into account both clinical data and the athlete’s personal goals.
• Emergency preparedness plays a key role: availability of defibrillators, CPR training, and established response protocols are essential. This personalized approach helps ensure safety while preserving the quality of life for young athletes.

Abstract

Sudden cardiac death (SCD) in children and adolescents is a rare but potentially catastrophic event, particularly in the context of athletic activity. Despite its low incidence, SCD significantly impacts strategies for screening, clearance, and monitoring of young athletes. The aim of this review is to summarize current data on the epidemiology, etiology, risk factors, and clinical management of pediatric patients at risk of sudden cardiac arrest during physical exertion. The most common causes of SCD in the pediatric population include hypertrophic cardiomyopathy, coronary artery anomalies, dilated and arrhythmogenic cardiomyopathies, inherited channelopathies (including long QT syndrome and catecholaminergic polymorphic ventricular tachycardia), as well as congenital heart defects and aortopathies. This review emphasizes the underlying pathophysiological mechanisms linking exercise to arrhythmogenesis and highlights the importance of individualized risk stratification using ECG, exercise testing, cardiac imaging, and genetic evaluation. Contemporary guidelines from major professional organizations (AHA/ACC/AMSSM/HRS/PACES/SCMR) increasingly advocate for a shared decision-making approach, moving away from blanket restrictions. This model considers both clinical risk and the athlete’s personal goals and values. Emergency preparedness in athletic settings is also discussed, including staff training and the strategic placement and maintenance of automated external defibrillators. This review aims to inform a personalized, evidence-based approach to sports eligibility for children and adolescents with cardiovascular conditions, helping to ensure a careful balance between safety and quality of life through collaborative planning, education, and emergency readiness.

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