Sudden cardiac arrest during sexual intercourse

Background Considerable apprehension often surrounds the issue of sudden cardiac arrest (SCA) during physical activity, and especially SCA related to sexual activity, which has not been well studied in the community. Purpose We sought to assess the burden, characteristics and outcomes of SCA related to sexual activity compared to other physical activities. Methods In this multicentre prospective ongoing study in the general population, every case of SCA was exhaustively collected. Data from all SCA during physical activity, alive at hospital admission, were analyzed with a specific focus on cases occurring during sexual intercourse. Results Among the 3028 SCAs admitted alive out of a total of 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 246 (8.1%) SCA (219 men, 89.0%) occurred during physical activity: 138 (56%) during sports, 91 (37%) during moderate-intensity activity and 17 (7%) during (hetero-) sexual intercourse. SCA during sexual activity were more likely to be male (100.0 vs. 88%, P  = 0.22), with higher no flow (8.4 vs. 3.1 min, P P  = 0.01) compared to others. There was no difference for age (53.0 vs. 56.1 years old, P  = 0.43), cardiovascular risk (CVR) profile (≥ 1 CVR factor, 81.2 vs. 75.6%, P  = 0.65), frequency of warning symptoms (37.5 vs. 53.6%, P  = 0.23) and family history of coronary artery disease (CAD) (6.3 vs. 11.5%, P  = 0.59). However, bystander CPR (47.1 vs. 80.3%, P  = 0.004) and survival rate (11.8 vs. 50.2%, P  = 0.002) were lower. Acute CAD (52.3%), and subarachnoid hemorrhage (29.4%), were the main identified causes followed by chronic CAD (17.6%) and structural non-ischemic heart disease (5.6%). Conclusion SCA during sexual intercourse is a relatively rare cause of SCA and is associated with a particularly poor outcome. The low rate of CPR in this setting may be related to the uniquely private circumstances of the arrest and could contribute to low survival rate.