**4. Сommotio cordis**

*Sudden Cardiac Death*

suddenly each year [8].

**3. SCD and types of sports**

accounted for less than 1%.

and 1 in 77,061 in basketball.

**2. The epidemiology of SCD in sports**

It is not easy to determine the accurate epidemiology of SCD in sports. Much depends on the selected inclusion criteria for the analysis, the age of the athletes, the level of athletic achievement, sporting experience, type of sports, and other factors. Therefore, studies carried out in different countries show an unequal SCD incidence rate in athletes. Between 1980 and 2011, the Sudden Death in Young Athletes Registry in the USA, which was developed based on mass media information, recorded 2406 cases of sudden death, which were observed in 29 divers sports [6]. In this paper 80% SD occurred in high school/middle school or collegiate student athletes, and 20% were engaged in organized youth, postgraduate.

SCD incidence rate determined in the USA was 7.47 and 1.33 per 1,000,000 exercising male and female school-age athletes, respectively [10]. The statistical data can however vary greatly in some areas. According to Corrado et al. [3], the SCD incidence rate in Italy was 2.6 cases in men and 1.1 in women per 100,000 individuals per year who are involved in active competitive sports. In recent years, with screening of athletes before active exercise, this figure decreased to 0.87 cases per 100,000 per year. In the USA, in children and adolescent athletes, SCD is registered in 0.66 cases per 100,000 exercising male school students and 1.45 per 100,000 male college students and 0.12 per 100,000 female school students and 0.28 per 100,000 female college students (Van Camp et al., [10]). In Ireland [11] the SCD incidence rate in sports was 1 case per 600,000, while in a French study [12], it was 0.26 per 100,000 per year. In a study conducted on Rhoda Island [13], the rate was 0.36 per 100,000 per year in individuals aged up to 30 years and 4.46 and 0.05 per 100,000 per year in men and women older than 30, respectively. The European Heart Rhythm Association (EHRA) position paper concluded that as an overall estimate, 1–2 out of 100,000 athletes between the ages of 12 and 35 years old die

The data on sports-associated SCD cases as well as those on epidemiology are quite varied, depending on national sporting traditions, age, gender, and group inclusion criteria (professional sports, school sports, general fitness activity). Most SCD causes in the USA [6], most SCD cases in young athletes in active competitive sports occurred in basketball and football, which accounted for 35 and 30%, respectively; soccer, cross-country/track, and baseball accounted for 8, 7, and 6% of the cases respectively; such sports as wrestling, boxing, swimming, ice hockey, and marathon running accounted for between 1 and 5%; and rugby, triathlon, martial arts, tennis, volleyball, gymnastics, figure skating, golf, and others

By another study from the USA (Harmon et al. [5]), the highest incidence rates of SCD per athletes were 1 in 8978 in men's basketball, 1 in 23,689 in men's soccer, and 1 in 35,951 in men's football. In women its rates were 1 in 57,611 in swimming

SCDs not associated with commotio cordis (see below) were reported most frequently in children and adolescents involved in ice hockey, football, and basketball [14]. In Spain SCD was observed most often in cyclists (34.4%), soccer players (21.3% in the general group and 33.3% in athletes younger than 35 years), and gymnasts (8%). Fewer deaths occurred in basketball, rowing, marathon running, jogging, and mountain climbing [15]. In Italy [3] the highest number of SCD cases was registered in soccer (40%); 9% of the cases in swimming and rugby; 7% in

**52**

The SCD cases associated with a blunt blow to the heart area and classified as death caused by heart contusion (contusion cordis) or concussion (commotio cordis) constitute a special group [14, 17–19]. Occurring in the vulnerable phase of the cardiac cycle (the beginning of T wave on ECG), this blow initiates fatal arrhythmias, ventricular fibrillation, or at once asystole. Under normal heart rate (60–80 bpm), this vulnerable period takes up approximately 2–3% of the time or up to 20% if the heart rate increases to 120 bpm or more. Therefore, athletes are more vulnerable to this grave complication during exercise. Young American athletes most frequently experience SCD in lacrosse, then hockey and basketball [14]. There have been reports of SCD occurring from a punch to the heart in martial arts, due to being struck with a hockey puck, or other circumstances. Сommotio сordis is the cause of 2 [5] to 20% [6, 7, 14] of SCD cases in young athletes.
