Editorial article
Sudden death in the athlete
Muerte súbita en el deportista
Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Serveis Mèdics F. C. Barcelona, Àrea Mèdica, Consell Català de l’Esport, Generalitat de Catalunya, Barcelona, Spain
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C. Barcelona, Àrea Mèdica, Consell Català de l’Esport, Generalitat de Catalunya, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Muerte súbita en el deportista" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The benefits of sport on population health are indisputable; in the Western world, more people continue to die due to not doing sport in comparison with those that do it. Therefore, the various health administrations are promoting physical exercise as a preventive measure and is certainly one of the most cost-effective measures ever implemented. However, in recent decades the practice of sports enjoys massive popularity and the number of popular competitions has kept growing, as well as the intensity with which the sport is practiced.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This concept of sport as a preventive measure for disease and as a health promoter is questioned when an episode of sudden death occurs in an athlete, a phenomenon that causes great alarm in the media and has a high social impact. The incidence of sudden death in athletes is between 0.5–3 per 100,000<span class="elsevierStyleHsp" style=""></span>cases/year according to different series.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1–3</span></a> Despite the limitations in existing records, the lack of a centralized data source and the fact that these estimates are frequently based on information found in the media, these figures are more or less constant in the medical literature. It occurs most often in black athletes, male (6 per 100,000/year) and first division players, which corresponds to the subjects that are theoretically under the most demanding and intensive training.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> Finally, the incidence described has also varied according to the sport played, e.g., it that seems to be more common in basketball players<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> and less common in middle-distance runners.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In most cases, the sudden death in the athlete is caused by an underlying heart disease, either hereditary or acquired. In young people, under 35 years of age, the most frequent causes are hypertrophic cardiomyopathy (affecting, worldwide, one in every 500 people), arrhythmogenic cardiomyopathy and other situations such as the anomalous origin of the coronary arteries or channelopathies. In elderly subjects, coronary artery disease is the underlying cause of sudden cardiac death, although its incidence among younger ages is steadily on the increase. Some series have recently shown that the main cause of death nowadays is sudden cardiac death of unknown origin, with a negative autopsy, which would correspond to 25–42% of all cases of sudden death in athletes.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">5,7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The causal relationship between sport and sudden death remains controversial. In Italy, since the early 1980s, all athletes must undergo a mandatory medical examination by law before participating in a competition or starting a professional sports program. In addition, forensic policy is stricter regarding the centralization of data from autopsy analysis. According to the situation in Italy,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> a study focused on analyzing the causal relationship between sudden death of cardiac origin and the sport: a population group was assessed, which was subdivided in athletes and non-athletes and the incidence of sudden cardiac death was compared in both subgroups; sudden death was almost 3 times more frequent in the group of athletes versus the non-athlete subjects of the same age and sex (2.3 vs 0.9 per 100,000/year). Also, the population of subjects who had experienced sudden death was subdivided according not exist or underlying heart disease; sudden death occurred more often in patients with an underlying heart disease who practiced sport compared to those who also had an underlying heart disease, but did not practice any sport. Thus, these data, although unique and limited by its retrospective nature indicate, among other things, a causal relationship between sports and sudden death in patients with an underlying heart disease. In subjects over 35 years of age, when the risk of sudden death is mainly related to the prevalence of coronary artery disease, exercise has also shown to increase the risk, especially when practiced occasionally.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">However, these studies are few and records of sudden death cases related to sports are very uneven and very inconsistent (mainly based on data published in the media); therefore, the causal relationship between heart disease and sudden death in sport is still controversial. Finally, the potential role of substance abuse (<span class="elsevierStyleItalic">doping</span>) or coexistent pharmacological treatments must also be considered as triggers of malignant arrhythmias and, therefore, as possible causes of death in this population.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">What is clear is that physical exercise results in an increased cardiac demand and an adrenergic discharge which, in many cases, cannot be handled by these pathological hearts. For this reason, in many of these diseases, physical exercise is contraindicated in different clinical guidelines, as in the case of hypertrophic cardiomyopathy, catecholaminergic ventricular tachycardia or arrhythmogenic right ventricular cardiomyopathy. It is therefore logical to assume that exercise acts at least as a trigger for arrhythmic events in individuals with heart disease.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In recent years, it has also been hypothesized that intense and continuous resistance training can lead to a specific cardiac remodeling in some individuals, which is characterized by dilation, hypertrophy and even myocardial fibrosis; sometimes presenting a difficult differential diagnosis with the initial stages of some cardiomyopathies.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> This myocardial substrate acquired and induced by chronic high-intensity resistance training would act as an arrhythmogenic substrate in some susceptible individuals. This is the underlying hypothesis linked with the observation of an increased incidence and prevalence of certain arrhythmias, such as atrial fibrillation, atrial flutter or ventricular tachycardia, in groups of athletes.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> In fact, the morphofunctional aspect of this remodeling, which mainly affects the atria and, characteristically, the right ventricle, is similar to that observed in arrhythmogenic right ventricular cardiomyopathy.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> Our group has also demonstrated, in an experimental model in rats, how resistance training can lead to the onset of myocardial fibrosis as well as to lowering the arrhythmia inducibility threshold.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> The mechanisms underlying these findings are still a matter of ongoing research and much controversy.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The non-negligible incidence of sudden death in athletes, its social and public health impact, as well as the fact that the underlying cardiac disorder could be potentially diagnosed in most cases if proper tests were carried out, raises the issue of active prevention of sudden cardiac death in athletes.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The first proposed measure is the availability of automated external defibrillators (AEDs) in stadiums and sports centers, with staff trained in basic cardiopulmonary resuscitation, creating “cardioprotected” spaces. The main determinant of survival in sudden arrhythmic death is the time to defibrillation, with a critical period of between 3 and 5<span class="elsevierStyleHsp" style=""></span>min. The effectiveness of AEDs has been widely demonstrated in public places. Fortunately, this measure has been largely facilitated by the simplification of the devices, which require virtually no expert staff intervention, although we are still far from universal implementation. Thus, the ARENA study showed that up to 28% of European football clubs surveyed had no AEDs in their stadiums, 36% did not have a written protocol in case of cardiac arrest, and, in 41% of cases, the transport time between the stadium (most of which had no AEDs) and the nearest hospital was more than 5<span class="elsevierStyleHsp" style=""></span>min.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a> Therefore, there is some way to go yet.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The other proposed action for the prevention of sudden death in athletes would be early diagnosis of any underlying heart disease that could act as a proarrhythmic substrate by the routine evaluation of cardiac health in athletes. The prevalence of cardiovascular disease with potential risk of sudden death in young athletes is between 0.2 and 0.7%.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> Most of these underlying cardiopathies that can potentially cause sudden death are not detectable before the episode of sudden death, unless specific tests are carried out, since most do not induce symptoms until the onset of malignant arrhythmia, especially in young people.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">This policy has been defended mainly on the Italian experience, in which, since the implementation in 1982 of a pre-participation screening program in the Veneto region, the annual rate of sudden death in athletes decreased from 3.6 to 0.4% per 100,000 people/year, mainly thanks to the detection of patients with cardiomyopathy. At the same time, the incidence of sudden death in athletes who were not evaluated showed no change, which shows that the significant reduction in mortality was not due to changes in the population, but rather to a real reduction in deaths due to heart disease.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> The Italian pre-participation policy is a systematic cardiac evaluation which includes a specific and targeted medical record, physical examination and a 12-lead electrocardiogram (ECG). However, despite evidence from the studies conducted in Italy, there are no other data that clearly confirm their experience. In fact, a study conducted in Israel, in which results were compared before and after the introduction of the systematic evaluation law regarding pre-participation screening in athletes, did not confirm the Italian results.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> However, the study conducted in Israel had significant limitations about the registry of sudden death cases, as it was based on what the media had published rather than in a centralized national register, as in the case of Italy. Finally, recent studies in the USA have also noted the potential cost-effectiveness of these pre-participation screening programs in athletes.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Therefore, based on the extensive Italian experience and the logic behind the fact that the evaluation of athletes would allow an early detection of the underlying heart disease, there is consensus regarding performing a cardiac evaluation in athletes. Nevertheless, there is still debate on what would be the ideal components of a systematic evaluation program. Several studies have shown that ECG is effective to improve sensitivity regarding case detection and diagnosis, especially when using modern criteria for the interpretation of ECG in athletes, which requires specifically trained personnel due to the peculiarities of cardiac adaptation in these subjects.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> Despite improved diagnostic ECG criteria, we know that this does not detect all heart diseases that could predispose to sudden death. In fact, the limited predictive diagnosis role of ECG has been considered as basis to include a stress test and an echocardiography as part of the screening programs. In Catalonia, a common strategy has been adopted to evaluate all affiliated athletes, including a targeted questionnaire, a physical examination and an ECG, and adding a stress test and an echocardiogram in the case of high performance athletes or those who practice sports with a greater physical demand.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In conclusion, despite the controversy over the optimal method of evaluation, it seems logical to think that athletes should be at least informed about the possibility and potential of this type of screening programs. The clinical implications of early detection programs are essentially the disqualification of certain athletes, but also the unique opportunity to increase our knowledge of cardiovascular pathophysiology during exercise and improve our therapeutic potential. The challenge of eliminating sudden cardiac death in athletes is a joint venture between the community, the athletes and society, encouraging athletes to access health professionals who are experts on cardiovascular adaptation to exercise, ensuring adequate emergency coverage in places where sport activities take place and, finally, promoting cardiopulmonary resuscitation competence in the community.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sitges M, Brugada J. Muerte súbita en el deportista. Med Clin (Barc). 2016;147:540–542.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of sports: do we need a pre-participation screening for competitive and leisure athletes?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Corrado" 1 => "C. Schmied" 2 => "C. Basso" 3 => "M. Borjesson" 4 => "M. Schiavon" 5 => "A. Pelliccia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehq482" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2011" "volumen" => "32" "paginaInicial" => "934" "paginaFinal" => "944" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21278396" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0110" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sudden death in young athletes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.J. Maron" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra022783" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2003" "volumen" => "349" "paginaInicial" => "1064" "paginaFinal" => "1075" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12968091" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0115" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sports-related sudden death in the general population" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Marijon" 1 => "M. Tafflet" 2 => "D.S. Celermajer" 3 => "F. Dumas" 4 => "M.C. Perier" 5 => "H. Mustafic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.110.008979" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2011" "volumen" => "124" "paginaInicial" => "672" "paginaFinal" => "681" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21788587" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0120" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of sudden cardiac death in national collegiate athletic association athletes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.G. Harmon" 1 => "I.M. Asif" 2 => "D. Klossner" 3 => "J.A. Drezner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.110.004622" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2011" "volumen" => "123" "paginaInicial" => "1594" "paginaFinal" => "1600" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21464047" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0125" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence, cause, and comparative frequency of sudden cardiac death in national collegiate athletic association athletes: a decade in review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.G. Harmon" 1 => "I.M. Asif" 2 => "J.J. Maleszewski" 3 => "D.S. Owens" 4 => "J.M. Prutkin" 5 => "J.C. Salerno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.115.015431" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2015" "volumen" => "132" "paginaInicial" => "10" "paginaFinal" => "19" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25977310" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0130" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Registry on acute cardiovascular events during endurance running races: the prospective RACE Paris registry" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Groupe de Réflexion sur la Cardiologie Interventionnelle" "etal" => true "autores" => array:6 [ 0 => "B. Gerardin" 1 => "J.P. Collet" 2 => "H. Mustafic" 3 => "A. Bellemain-Appaix" 4 => "H. Benamer" 5 => "J. Monsegu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehv675" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2016" "volumen" => "37" "paginaInicial" => "2531" "paginaFinal" => "2541" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26715168" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0135" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Etiology of sudden death in sports: insights from a United Kingdom regional registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Finocchiaro" 1 => "M. Papadakis" 2 => "J.L. Robertus" 3 => "H. Dhutia" 4 => "A.K. Steriotis" 5 => "M. Tome" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2016.02.062" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2016" "volumen" => "67" "paginaInicial" => "2108" "paginaFinal" => "2115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27151341" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0140" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does sports activity enhance the risk of sudden death in adolescents and young adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Corrado" 1 => "C. Basso" 2 => "G. Rizzoli" 3 => "M. Schiavon" 4 => "G. Thiene" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2003" "volumen" => "42" "paginaInicial" => "1959" "paginaFinal" => "1963" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14662259" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0145" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Triggering of sudden death from cardiac causes by vigorous exertion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.M. Albert" 1 => "M.A. Mittleman" 2 => "C.U. Chae" 3 => "I.M. Lee" 4 => "C.H. Hennekens" 5 => "J.E. Manson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM200011093431902" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2000" "volumen" => "343" "paginaInicial" => "1355" "paginaFinal" => "1361" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11070099" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0150" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leisure-time physical activity and the risk of primary cardiac arrest" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.N. Lemaitre" 1 => "D.S. Siscovick" 2 => "T.E. Raghunathan" 3 => "S. Weinmann" 4 => "P. Arbogast" 5 => "D.Y. Lin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Intern Med" "fecha" => "1999" "volumen" => "159" "paginaInicial" => "686" "paginaFinal" => "690" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10218747" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0155" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular monitoring of children and adolescents with heart disease receiving medications for attention deficit/hyperactivity disorder [corrected]: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V.L. Vetter" 1 => "J. Elia" 2 => "C. Erickson" 3 => "S. Berger" 4 => "N. Blum" 5 => "K. Uzark" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.107.189473" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2008" "volumen" => "117" "paginaInicial" => "2407" "paginaFinal" => "2423" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18427125" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0160" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exercise – is it possible to have too much of a good thing?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. La Gerche" 1 => "D.L. Prior" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.hlc.2007.03.014" "Revista" => array:7 [ "tituloSerie" => "Heart Lung Circ" "fecha" => "2007" "volumen" => "16" "numero" => "Suppl. 3" "paginaInicial" => "S102" "paginaFinal" => "S104" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17606401" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0165" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arrhythmias and sport practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Mont" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/hrt.2008.160903" "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "2010" "volumen" => "96" "paginaInicial" => "398" "paginaFinal" => "405" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20197369" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0170" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac arrhythmogenic remodeling in a rat model of long-term intensive exercise training" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Benito" 1 => "G. Gay-Jordi" 2 => "A. Serrano-Mollar" 3 => "E. Guasch" 4 => "Y. Shi" 5 => "J.C. Tardif" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.110.938282" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2011" "volumen" => "123" "paginaInicial" => "13" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21173356" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0175" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Time for action regarding cardiovascular emergency care at sports arenas: a lesson from the Arena study" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Sports Cardiology Section of the European Association of Cardiovascular Prevention and Rehabilitation, European Society of Cardiology" "etal" => true "autores" => array:6 [ 0 => "M. Borjesson" 1 => "D. Dugmore" 2 => "K.P. Mellwig" 3 => "F. van Buuren" 4 => "L. Serratosa" 5 => "E.E. Solberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehq006" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2010" "volumen" => "31" "paginaInicial" => "1438" "paginaFinal" => "1441" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20197422" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0180" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Corrado" 1 => "C. Basso" 2 => "A. Pavei" 3 => "P. Michieli" 4 => "M. Schiavon" 5 => "G. Thiene" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.296.13.1593" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2006" "volumen" => "296" "paginaInicial" => "1593" "paginaFinal" => "1601" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17018804" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0185" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mandatory electrocardiographic screening of athletes to reduce their risk for sudden death: proven fact or wishful thinking" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Steinvil" 1 => "T. Chundadze" 2 => "D. Zeltser" 3 => "O. Rogowski" 4 => "A. Halkin" 5 => "Y. Galily" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2010.10.037" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2011" "volumen" => "57" "paginaInicial" => "1291" "paginaFinal" => "1296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21392644" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0190" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular screening in college athletes with and without electrocardiography: a cross-sectional study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.L. Baggish" 1 => "A.M. Hutter Jr." 2 => "F. Wang" 3 => "K. Yared" 4 => "R.B. Weiner" 5 => "E. Kupperman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/0003-4819-152-5-201003020-00004" "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2010" "volumen" => "152" "paginaInicial" => "269" "paginaFinal" => "275" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20194232" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0195" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ESC criteria for ECG interpretation in athletes: better but not perfect" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Sharma" 1 => "S. Ghani" 2 => "M. Papadakis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/heartjnl-2011-300400" "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "2011" "volumen" => "97" "paginaInicial" => "1540" "paginaFinal" => "1541" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21708815" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0200" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consens per a la prevenció de la mort sobtada cardíaca en els esportistes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Sitges" 1 => "J.A. Gutiérrez" 2 => "J. Brugada" 3 => "R. Balius" 4 => "M. Bellver" 5 => "D. Brotons" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.apunts.2012.07.004" "Revista" => array:5 [ "tituloSerie" => "Apunts Med Esport" "fecha" => "2013" "volumen" => "48" "paginaInicial" => "35" "paginaFinal" => "41" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014700000012/v1_201702040025/S2387020616307987/v1_201702040025/en/main.assets" "Apartado" => array:4 [ "identificador" => "46797" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014700000012/v1_201702040025/S2387020616307987/v1_201702040025/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616307987?idApp=UINPBA00004N" ]
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