A review in the New England Journal of Medicine signals a shift in sports cardiology: many athletes who survive sudden cardiac arrest (SCA) can safely return to competition after appropriate treatment.
The review analyzed 13 studies (2003–2024) and found SCA incidence varies by demographic factors. Male athletes face a higher risk than females, and Black college athletes experience elevated rates (~1 in 18,000 athlete-years). Sports with the highest incidence include basketball, soccer, tackle football, ice hockey, and cross-country. For athletes under 25, congenital and structural diseases are primary causes; for those over 25, coronary artery disease predominates.
Optimal screening remains debated. History and physical examination show low sensitivity with high false-positive rates; 12-lead ECG detects roughly two-thirds of at-risk disorders but increases costs; echocardiography adds complexity. The appropriate strategy depends on available resources and population risk.
Historically, an SCA event or an implantable cardioverter-defibrillator (ICD) ended athletic careers. However, a multinational registry of 201 athletes with ICDs recorded no deaths or arrhythmia failures during sports at 44-month follow-up. The 2025 AHA-ACC statement and 2024 Heart Rhythm Society consensus now consider return to play “reasonable” through shared decision-making involving the athlete, family, clinicians, and team stakeholders.
The review emphasizes well-rehearsed emergency action plans with AEDs, clinicians familiar with athletic cardiac adaptation for test interpretation, and assessment of psychological readiness before clearance.
Published in: New England Journal of Medicine (2026)
