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Sudden cardiac arrest isn't as rare in the young as we'd like to think. Can it be prevented?

The Telegraph logo The Telegraph 13/6/2021 Luke Mintz
a group of football players posing for a picture: Christian Eriksen's teammates form a protective ring around him on Saturday. The Danish midfielder received chest compressions on pitch - Shutterstock/Wolfgang Rattay/POOL/EPA-EFE/Shutterstock  © Shutterstock/Wolfgang Rattay/POOL/EPA-EFE/Shutterstock Christian Eriksen's teammates form a protective ring around him on Saturday. The Danish midfielder received chest compressions on pitch - Shutterstock/Wolfgang Rattay/POOL/EPA-EFE/Shutterstock 

It was ten minutes of brutal, heart-pounding terror, a moment so frightening that fans had to look away in horror. At Copenhagen’s Parken Stadium on Saturday, some 16,000 spectators fell silent as 29-year-old Christian Eriksen - an outwardly healthy midfielder, bursting with youthful vigour - fell to the pitch face first shortly before half-time at Denmark’s opening Euro 2020 fixture against Finland. Medics ran on the pitch to administer chest compressions. The Danish team consoled Eriksen’s distraught wife, Sabrina Kvist Jensen, and formed a circle around their teammate, protecting his dignity from the glare of cameras.

Blessedly, Eriksen pulled through. The father-of-two was later confirmed to be stable in hospital, from where he passed on “greetings” to his teammates. The exact cause of Eriksen’s collapse remains unclear; Denmark head coach Kasper Hjulmand described it vaguely as a “heart issue”. Whatever the cause, the unnerving sight of Eriksen receiving potentially life-saving cardiopulmonary resuscitation (CPR) treatment from pitch-side doctors has focused minds on that incredibly rare but stubbornly persistent issue that has plagued young athletes for as long as we can remember: the risk of sudden cardiac arrest.

It is a rare and poorly-understood condition about which scientists knew very little, until fairly recently. Deaths were described simply as “unexplained”; grieving families were left without answers. But innovations in heart-screening technology have provided clues. Whilst heart attacks occur when an artery is blocked, and mostly affect middle-aged or elderly people, sudden cardiac arrest is usually caused by an inherited heart condition (like Long QT syndrome or Brugada syndrome), and mostly affects the young. Among under-35s, it is the third most common cause of death, behind suicide and road accidents. Athletes are at particular risk.

If you have one of these conditions, your heart will probably beat normally for most of your life. But there’s a small chance that at some point, without warning, the electrical signals that move around your heart will falter, causing the bottom section of your heart to start beating very quickly (faster, crucially, than the top section of the heart). Soon, the heart starts to quiver and becomes unable to pump blood.

For those with an inherited condition, sudden cardiac arrest can occur anywhere, but it’s most likely to strike during vigorous physical exercise. For then 23-year-old Premier League footballer Fabrice Muamba, it happened 43 minutes into an FA Cup match at Tottenham’s White Hart Lane, in 2012, in full view of 36,000 spectators - an incident with striking parallels to the terrifying ordeal experienced by Christian Eriksen on Saturday. Muamba’s heart stopped for 78 minutes; it's likely that he only survived because he received CPR within minutes from Tottenham’s five pitchside assistants. Of those who have a cardiac arrest outside hospital, only about one in 10 survive. Muamba had to retire from football for life, a decision he described as “devastating”.

Ryo Miyaichi et al. standing next to a football ball: Fabrice Muamba is treated by pitch-side medics after collapsing at Tottenham's White Hart Lane in March 2012 - Richard Heathcote/Getty Images Sport © Provided by The Telegraph Fabrice Muamba is treated by pitch-side medics after collapsing at Tottenham's White Hart Lane in March 2012 - Richard Heathcote/Getty Images Sport

After a handful of tragic incidents, in 1997 the Football Association (FA) implemented routine screening of football players at 16 or 17, before they sign a professional contract. In 2017, with two decades of data under their belt, doctors in charge of the programme concluded that sudden cardiac death is much more common than previously thought, killing as many as one in 14,700 young athletes, considerably higher than previous estimates of one in 50,000 and one in 200,000, according to the findings published in the New England Journal of Medicine.

Routine screening has spread into other sports, too. In 2016, England cricketer James Taylor, then 26, had to retire from his beloved sport after a heart test found a rare, genetic condition that could be exacerbated by exercise. Taylor later said the diagnosis turned his world “upside down”. In Italy, screening of competitive athletes has been mandatory since 1982; since then, cases of young sudden cardiac death have reportedly dropped by 89 percent.

And now, some campaigners argue that heart screening should be offered much more widely - not just for those in professional sport. In the UK, the NHS will usually only offer heart screening if your biological relative has experienced an unexplained cardiac arrest. But the charity Cardiac Risk in the Young (CRY) thinks screening should be more widespread, and offers subsidised screening for anybody between 14 and 35, for £50 each. It is funded mostly by grieving families devastated by the condition. Screening is particularly recommended for any young people experiencing exercise-related chest pain, breathlessness or heart palpitations.

Indeed, some families wonder whether routine heart screening might have saved their loved one’s life. That is the view of Patrick Mead, 19, whose sister Lauren died in 2019. We usually associate sudden cardiac arrest with the sweaty heat of a football pitch, but for Lauren, it arrived in her sleep. It was a Sunday morning in October; Patrick remembers he had just finished breakfast when he noticed Lauren hadn’t yet left her bedroom. The siblings worked together at a restaurant near their family home in Frome, Somerset. They had a shift that morning and Lauren was going to be late. Their mother walked upstairs to check on Lauren – and that was the point at which their “world just stopped”, Patrick remembers.

Her parents laid her on her bedroom floor and gave her CPR. In a recording of a 999 call made that morning, Patrick’s mother can be heard sobbing down the phone, telling the operator: “She’s blue … she’s gone.” Patrick struggled to comprehend the news. “You’d be sitting at home and you’d almost expect the door to open and [Lauren] to come through,” he recounted to the Telegraph earlier this year. “There were a few times I’d think, ‘Oh I can’t wait to tell Lauren that’. And then, ‘Oh I can’t’. That was quite difficult.”

a man standing in front of a crowd: Denmark's Simon Kjaer consoles Christian Eriksen's distraught wife, Sabrina Kvist Jensen, at Saturday's match - Shutterstock © Provided by The Telegraph Denmark's Simon Kjaer consoles Christian Eriksen's distraught wife, Sabrina Kvist Jensen, at Saturday's match - Shutterstock

Keen to find clues to explain Lauren’s death, Patrick’s parents underwent heart screening at London’s St George’s Hospital, one of the UK’s leading centres for identifying and preventing sudden cardiac arrest in the young. Ultimately, doctors couldn’t find evidence of any genetic condition. It proved something of a double-edged sword: a relief on the one hand, Patrick says, but “with nothing showing up on our tests, you still don't know 100 per cent what happened to Lauren. Was it genetics, or was it something else? I guess we just don't know at the moment.”

Patrick wonders whether routine heart screening might have saved his sister’s life. But experts aren't so sure. In a meta-analysis in 2016, a team of Belgian researchers argued that because inherited heart conditions are so rare, mass screening might actually do more harm than good. Writing in the British Medical Journal, they suggested that electrocardiograms (the main method of testing for these conditions) are flawed, and that heart screening would only raise the red flag in about three percent of young people who go on to die from sudden cardiac arrest. What’s more, they suggested that mass screening might wrongly flag a number of people who are unlikely ever to experience problems. Young people would become anxious, they argued, and some athletes would have to quit sport unnecessarily, potentially discouraging young people from exercise.

For now, the UK’s National Screening Committee seems to agree. They do not recommend routine heart screening for young people because they say there is not enough evidence that existing heart-screening technology correctly identifies problems. But after Christian Eriksen's terrifying experience on Saturday - one that caught the eye of the entire sporting world - that debate may well reopen.

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