Response to: Szuster-Ciesielska, Letter to the Editor Regarding ‘Autopsy Findings in Cases of Fatal COVID-19 Vaccine-Induced Myocarditis’

We appreciate concerns expressed by Szuster-Ciesielska about COVID-19 vaccination playing a role in sudden unexplained deaths reported in athletes after the institution of mandates in Europe. Cadegiani has pointed out that in the setting of COVID-19 vaccine induced myocarditis, a surge of catecholamines may play a role in the initiation of lethal ventricular arrhythmias and cardiac arrest.1 In the absence of an autopsy after unexplained death in a previously healthy player, antecedent COVID-19 vaccination and subclinical myocarditis would be reasonable consideration given the findings reported in our paper,2 and as inferred by the work of Polykretis and McCullough.3 Importantly, Polykretis and McCullough re-analysed the data in response to a letter to the editor: ‘We stratified by age and found 558 athletes were ≤35 years and 139 were over 35 years. Such number of documented events is likely largely underestimated, because of the difficulty to gather data from countries where the script/alphabet is not translatable. Notably, in a 38-years timespan (1966-2004), 1101 athletes under the age of 35 died (~29/year) due to various heart-related conditions, 50% of whom had congenital anatomical heart disease and cardiomyopathies and 10% had atherosclerotic heart disease with early onset. The finding of 697 deaths from 2021 forward [<24 months] is concerning for a secular change and these data suggest a research registry for athletes with sudden unexpected cardiac arrest should be initiated with particular attention to COVID-19 vaccine administration data’.3 In other words, a nearly 10-fold increase in sudden death after rollout of COVID-19 vaccination was observed. The report relied upon a public blog of athlete deaths that required multiple press releases for confirmation death occurred in an active player.4 At this time, there is no scientific registry that collates sudden death reports among vaccinated players, however, our present paper suggests such a registry would be important and valuable to the field. In conclusion, our paper contributes valuable knowledge to the understanding of fatal COVID-19 vaccine-induced myocarditis, adhering to rigorous scientific standards while navigating the challenges of sourcing generalizable observations in a novel and rapidly evolving field. We thank Szuster-Ciesielska for their careful analysis and share their concerns regarding the sharp increase in sudden death among athletes during the period where COVID-19 vaccine mandates were enforced among European sports teams. RH and WM are no longer associated with The Wellness Company. PM receives salary support (modest) or equity (modest) in The Wellness Company, which had no role in the original manuscript or in this correspondence.

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