Though rare, sudden cardiac arrest (SCA) in athletes often unfolds in high-visibility settings, like sports arenas, prompting questions about underlying causes, emergency preparedness, and long-term outcomes. A new review by Yale School of Medicine's Rachel Lampert, MD, published in the New England Journal of Medicine, offers a comprehensive examination of these events — spanning incidence, diagnosis, prevention strategies, and decision-making around return to play.
SCA is often the first symptom of an undiagnosed heart condition in young athletes. While rare, it can occur during intense physical activity. Primary causes of SCA in athletes include inherited structural heart diseases like hypertrophic cardiomyopathy, electrical disorders such as Long QT syndrome, and congenital abnormalities. These underlying conditions can be difficult to detect without proactive screening.
“Sudden cardiac arrest in athletes generates significant public attention, but there’s still a need for further consolidated clinical guidance.”
Lampert, Robert W Berliner Professor of cardiovascular medicine
“This review was designed to give providers a full introduction — from identification of those at risk to return-to-play conversations.”
The review, also authored by Kimberly Harmon, MD, from the University of Washington, emphasizes two major strategies for prevention. Primary prevention, or identifying heart conditions before they occur, includes the use of electrocardiogram (EKG) screening, which has been adopted by roughly half of National Collegiate Athletic Association programs and is used at Yale as part of its standard athlete clearance process. While EKGs increase the ability to detect hidden heart conditions, Lampert notes that acquiring one is only the first step and must be followed by expert interpretation and appropriate follow-up care.
Secondary prevention, or the immediate, organized actions taken after a cardiac arrest occurs, is aimed at preventing ensuing sudden cardiac death. This includes having a clearly defined emergency action plan in place — ensuring responders know who will initiate CPR, retrieve and use an automated external defibrillator, and coordinate next steps once the patient is stabilized.
As discussed in the review, after a diagnosis of cardiac disease is made, either by pre-participation screening, other types of screening, or if an athlete is diagnosed based on symptoms, shared decision-making — a clinical approach that prioritizes patient values alongside medical expertise — is critical. Historically, athletes diagnosed with cardiac conditions were often barred from returning to play based on rigid guidelines. Lampert’s own NIH-funded study, as well as studies by other investigators, however, have shown that some athletes — if properly treated and monitored — may resume sports without excess risk.
Shared decision-making shifts the process from blanket restrictions to a tailored conversation that takes into account the athlete’s risk tolerance, goals, and treatment options, Lampert says.
“By highlighting ongoing gaps, particularly in the study of less common inherited heart conditions, the review serves an important role in bridging fragmented knowledge,” Lampert says, noting that future research will be critical in expanding the evidence base and refining return-to-play protocols for affected athletes.
“Our goal is to support clinicians and patients alike in navigating these complex decisions,” Lampert says. “It’s about combining science, risk assessment, and autonomy in a space where all three matter deeply.”
Cardiovascular Medicine, one of 10 sections in the Yale Department of Internal Medicine, is dedicated to improving cardiovascular health by advancing groundbreaking research, training the next generation of experts in cardiology, and delivering world-class patient care to people with a range of cardiovascular issues. To learn more, visit Cardiovascular Medicine.
(Newswise/HG)
