A systematic review of explainable artificial intelligence and cardiac electrophysiological models addressing sports-related sudden cardiac death and arrest in adolescents and young adults

Journal article

Sudden Cardiac Death (SCD) is a fatal event occurring within one hour of a witnessed or 24 hours of an unwitnessed Sudden Cardiac Arrest (SCA), being the leading medical cause of death among adolescent and young adult athletes. We examined the epidemiology of sports-related SCD (SrSCD) and SCA (SrSCA) incidence in adolescents and young adults, explainable Artificial Intelligence (xAI) applied to life-threatening arrhythmias, and cardiac electrophysiological models. We systematically searched peer-reviewed studies from eight databases between 2013-2025 (PROSPERO: CRD42024565960), using PROBAST for bias assessment. From 9574 studies, we included 84 (incidence: 16, xAI: 30, modelling: 38). SrSCD incidence ranged from 0.1 to 0.6 per 100,000 participants per year. Gradient-weighted Class Activation Mapping dominated as xAI technique. Cardiac electrophysiological models predominantly focused on cellular and tissue-level electrophysiology. We advocate for standardised SrSCD/SrSCA definitions and integration of epidemiological risk factors with xAI and cardiac modelling frameworks to advance athlete-specific risk stratification.

Authors: Vanegas Müller, E; Srikijkasemwat, N; Gan, A; Raman, B; Harford, M

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Nature Research
• Journal: npj Digital Medicine
• Publication date: 2026-06-11
• DOI: 10.1038/s41746-026-02878-x
• EISSN: 2398-6352
• ISSN: 2398-6352
• Language: English
• Keywords: Sudden cardiac death; Incidence (geometry); Sudden cardiac arrest; Sudden death; Epidemiology; Young adult