HNS and St Catherine Specialty Hospital Invite Christian Eriksen to Zagreb for Genetic Testing

Daniela Rogulj

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St Catherine Specialty Hospital Management Board president and Croatian Football Federation health commission president Dragan Primorac sent a letter to the Danish Football Federation president Jesper Moller and Secretary-General Jakob Jensen, urging them to have their national team member Christian Eriksen (29) perform a comprehensive genetic test in Croatia to determine the possible genetic basis of cardiac arrest, reports

The Denmark national team player shocked the world when he collapsed on the pitch in the 43rd minute of the match between Finland and Denmark on June 12. The doctors revived him on the pitch for ten minutes. Eriksen was transferred to the hospital, from where he later contacted his teammates, and they then decided to continue the match. He was then fitted with an ICD, a device that can restore normal heart function.

It is known that the Croatian Football Federation and the St Catherine Special Hospital, in cooperation with the American corporation Invitae, launched a project in June 2019 to prevent sudden cardiac death, which with a complete cardiac examination (12-channel electrocardiogram, heart ultrasound, ergometry, and 24-Holter) includes the most comprehensive analysis described in the literature genes associated with conditions that can lead to sudden cardiac death in athletes.

Eriksen’s genetic testing would be conducted as part of the project “Development of a Comprehensive Model for the Prevention of Sudden Heart Death: Analysis of 294 Genes and Related Mutations Associated with Conditions That Can Lead to Athlete’s Sudden Heart Death.”

If, after genetic testing, the occurrence of a mutation in one of the genes associated with conditions that can lead to the sudden cardiac death of an athlete is determined, it will be necessary to test his children as well. Eriksen, meanwhile, is fitted with an implantable cardioverter-defibrillator (ICD) that can successfully detect the occurrence of arrhythmias in the future and restore a normal heart rhythm and save a person’s life.

The first results related to the role of specific genetic markers as possible predictors of sudden cardiac death in athletes were conducted by scientists from the USA, Canada, Croatia, and Germany, led by Dr. Primorec, and recently published in the scientific journal Frontiers in Medicine.

The results of a study involving three generations of families of athletes who died of sudden cardiac death have been published, and the study has analyzed the largest number of genes associated so far with several inherited cardiac conditions leading to sudden cardiac death 294 genes.

Among the analyzed genes are those that lead to various disorders of the electrical activity of the heart, including hereditary disorders of cardiac ion channels, such as prolonged QT interval syndrome, Brugada syndrome, but also genes whose changes lead to structural changes in the heart, such as cardiomyopathies (most often hypertrophic cardiomyopathy), and several other conditions.

HNS President Davor Suker introduced FIFA leader Gianni Infantino and UEFA president Alexander Ceferin to the published, as it is now called, “Croatian model for the prevention of sudden cardiac death in athletes,” which includes the analysis of the largest number of genes associated with sudden cardiac death, especially in players from risk groups. 

During the start of the project in June 2019, a member of the project team and one of the most prominent German cardiologists, prof. Dr. Johannes Brachmann stated that the latest scientific findings suggest that classical cardiac examination is not sufficient in the early detection of conditions that can lead to sudden cardiac death in athletes and that genetic screening in predisposed athletes plays a key role.

It was then particularly emphasized that extremely intense physical activity can increase the risk of sudden cardiac death in predisposed athletes. Following the Guidelines (Positions) of the Croatian Society for Human Genetics of the Croatian Medical Association, all persons identified through screening as persons at higher risk will be provided with information as part of genetic counseling during risk identification and after additional tests. This will be the basis for optimal treatment and, if necessary, exclusion from sports of high-risk athletes to reduce the incidence of sudden cardiac death.

Since the beginning of the project “Development of a comprehensive model for the prevention of sudden cardiac death: Analysis of 294 genes and associated mutations associated with conditions that can lead to sudden cardiac death of athletes”, on two occasions, the Croatian Football Federation sent a letter to all First, Second and Third HNL clubs, First and Second HNLŽ clubs, and First and Second HNML clubs, urging all players from defined risk groups (athletes with a personal or family history of cardiovascular disease, athletes with a specific cardiovascular result after a clinical examination, athletes with previous episodes of weakness or excessive fatigue that are not in line with exertion, athletes with dizziness or unexplained loss of consciousness and chest pain, etc.) after standard cardiac treatments, and underwent genetic testing as part of the project.

At the end of the letter,  Dr. Primorac congratulated Denmark on advancing to the round of 16.

“It was tough for all of us to watch the recent scenes of Eriksen after he collapsed in the first half of the 2020 European Championship match between Denmark and Finland. The most important thing now is that he is well and that the medical team has done everything to stabilize his condition. However, the New England Journal of Medicine, one of the leading scientific journals, points out that in about 40% of cases of sudden cardiac death, the cause remains unknown. Therefore, I believe that genetics and other OMICS disciplines will play a key role in better understanding the mechanism occurrence and the prevention of these tragic events.

In our comprehensive model of sudden cardiac death prevention, in addition to standard cardiac tests, we placed special emphasis on the analysis of 294 genes associated with conditions that lead to sudden cardiac death. Therefore, as part of the project, we want to help colleagues from the Danish Football Association in searching for the real cause of cardiac arrest that happened to Eriksen, to optimize his treatment, but also to determine the possible existence of mutations associated with conditions that can lead to sudden cardiac death,” concluded Dragan Primorac.

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