Electrical Triggers of Adverse Events During the Baseball World Series

Adverse cardiovascular events occur more frequently during times of community stress, including natural disasters, wars and terrorist attacks, and even during competitive sporting events.1 When considering sporting events in particular, multiple studies have demonstrated higher rates of myocardial infarction, arrhythmias, and cardiovascular death—both between sports fans and within the overall regional population—during World Cup soccer,2,3 the National Football League's Superbowl,4 and hockey games.5 Many authors have attributed these population-level findings to hyperadrenergic tone or dietary and/or lifestyle changes during these events. Variables collected were age, sex, presence of cardiomyopathy, type of cardiomyopathy, arrhythmia history (including in particular any chart history of sustained atrial or ventricular tachyarrhythmias), cardiac medications, indication for device placement, most recent left ventricular ejection fraction (LVEF), and medication changes or hospitalizations during the World Series time period. Because patients served as their own controls, arrhythmias in the 2 time periods were compared using one-sided t tests for continuous variables, chi-square or Fisher's exact tests for categorical variables, or nonparametric alternatives, as appropriate. Previous studies in larger populations have demonstrated higher rates of adverse events, such as the 63% increase in sudden cardiac death during the 2002 World Cup soccer matches in Switzerland,3 but to our knowledge, ours is the first patient-level analysis of potential triggers for these outcomes.