Bickel Trenton, Gunasekaran Prasad, Murtaza Ghulam, Gopinathannair Rakesh, Gunda Sampath, Lakkireddy Dhanunjaya
Division of Cardiovascular Disease, University of Kansas Hospital and Medical Center, Kansas City, Kansas.
The Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas.
J Atr Fibrillation. 2019 Dec 31;12(4):2193. doi: 10.4022/jafib.2193. eCollection 2019 Dec.
Sudden cardiac death (SCD) in competitive athletes, though relatively uncommon, invariably leads to controversy. Specific limitations of an extensive screening process include lack of robust evidence to support prevention of SCD, poor cost-effectiveness and uncertain downstream implications of a positive screening test. An emerging body of evidence points to enhanced neurologically intact survival to hospital discharge when automated external defibrillators (AEDs) are used in a timely manner following sudden cardiac arrest (SCA). A viable alternative to an expansive screening process could be a robust secondary prevention system comprising of improvements in AED availability, stringent enforcement of CPR training in athletes and trainers to provide timely and effective resuscitation to reduce death following SCA. This strategy could widen the window to diagnose and treat the underlying etiology and prevent recurrence of SCA while also offering financial feasibility. Restricting athletes from competitive sports is a difficult decision for physicians owing to a lack of well-defined cutoffs for acceptable and prohibitive risk from pathology predisposing to SCD, especially in the absence of a protective medico-legal framework. In this review, we highlight a few cases that generated intense scrutiny by the public, media and medical professionals about the efficacy, feasibility and pitfalls of the existing screening process to diagnose cardiovascular pathology predisposing to SCD. Furthermore, contrasting approaches to screening, diagnosis and downstream workup protocols between the European Society of Cardiology and the American Heart Association are analyzed.
竞技运动员心源性猝死（SCD）虽然相对少见，但总会引发争议。广泛筛查过程存在特定局限性，包括缺乏有力证据支持预防SCD、成本效益不佳以及筛查结果呈阳性的下游影响不明确。越来越多的证据表明，在心脏骤停（SCA）后及时使用自动体外除颤器（AED），能提高患者神经功能完好存活至出院的几率。对于广泛的筛查过程而言，一个可行的替代方案可能是建立一个强有力的二级预防系统，包括增加AED的可及性、严格要求运动员和教练进行心肺复苏培训以提供及时有效的复苏，从而降低SCA后的死亡率。这一策略可以延长诊断和治疗潜在病因的时间窗口，预防SCA复发，同时在经济上也具有可行性。由于缺乏针对易患SCD的病理状况的可接受风险和禁止性风险的明确临界值，尤其是在缺乏保护性法律框架的情况下，医生很难做出限制运动员参加竞技运动的决定。在这篇综述中，我们重点介绍了一些引起公众、媒体和医学专业人士对现有诊断易患SCD的心血管病理状况的筛查过程的有效性、可行性和缺陷进行严格审查的案例。此外，还分析了欧洲心脏病学会和美国心脏协会在筛查、诊断及下游检查方案方面的不同方法。
