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We read with great interest the paper by Finocchiaro et al. regarding the causes of sudden cardiac death (SCD) in athletes and its precipitating factors (1).

The authors observed that SCD in athletes occurred at rest in almost 40% of the cases, a third of which occurred during sleep. This is substantially higher (more than 2-fold) than in the large cohorts published so far among athletes who had SCD (2,3). The authors specified that since 40% of SCDs occurred outside the context of exertion, it is highly unlikely that the provision of automated external defibrillators (AEDs) in public venues would have prevented SCDs among these athletes.

An important limitation has to be acknowledged before describing the circumstances of SCD occurrence. This study was based on autopsy series, and therefore, it only included patients who did not survive, which creates a potential bias. This is important to consider because SCDs that occur during sports are known to have a dramatically higher survival rate than those occurring outside the context of exercise (4). In addition, SCDs that occur during sleep are most likely to occur at home, where the survival rate is much lower than in public places (5).

Therefore, both SCDs occurring during sleep and those occurring outside the context of sport were probably overrepresented in this study, and a real estimation of the incidence of SCDs at rest cannot be accurately performed. In addition, cases of SCDs that were prevented by the use of AEDs on the field were not considered in this pathology study, and any conclusion regarding the impact of AEDs should be drawn with particular caution.

  • 1. Finocchiaro G., Papadakis M., Robertus al. : "Etiology of sudden death in sports: insights from a United Kingdom regional registry". J Am Coll Cardiol 2016; 67: 2108.

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  • 2. Maron B.J., Doerer J.J., Haas T.S., Tierney D.M. and Mueller F.O. : "Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006". Circulation 2009; 119: 1085.

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  • 3. Corrado D., Basso C., Rizzoli G., Schiavon M. and Thiene G. : "Does sports activity enhance the risk of sudden death in adolescents and young adults?". J Am Coll Cardiol 2003; 42: 1959.

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  • 4. Meyer L., Stubbs B., Fahrenbruch al. : "Incidence, causes, and survival trends from cardiovascular-related sudden cardiac arrest in children and young adults 0 to 35 years of age: a 30-year review". Circulation 2012; 126: 1363.

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  • 5. de Vreede-Swagemakers J.J., Gorgels A.P., Dubois-Arbouw al. : "Out-of-hospital cardiac arrest in the 1990’s: a population-based study in the Maastricht area on incidence, characteristics and survival". J Am Coll Cardiol 1997; 30: 1500.

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Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.