A systematic review of explainable artificial intelligence and cardiac electrophysiological models addressing sports

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.

E.V., L.H., and M.V. are funded by The Podium Institute for Sports Medicine and Technology. A.B. is supported by the Royal Society University Research Fellowship (Grant No. URF\R1\221314). P.L. acknowledges funding from the Oxford NIHR Biomedical Research Centre, Medical Research Council and British Heart Foundation. M.H. is funded by the National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre (BRC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Research in KG’s laboratory is funded by the British Heart Foundation (IA/F/23/275037).

The Podium Institute for Sports Medicine and Technology, Department of Engineering Science, University of Oxford, Oxford, UK

Erik Vanegas Müller, Liang He & Mauricio Villarroel

Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK

Erik Vanegas Müller, Nicharee Srikijkasemwat, Mirae Harford, Liang He, Abhirup Banerjee & Mauricio Villarroel

Department of Cardiovascular Sciences, University of Birmingham, Birmingham, UK

Division of Cardiovascular Medicine, Radcliffe Department of Medicine, and British Heart Foundation Centre of Research Excellence Oxford, University of Oxford, Oxford, UK

Betty Raman, Abhirup Banerjee, Katja Gehmlich & Paul Leeson

Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK

NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK

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Correspondence to Erik Vanegas Müller or Mauricio Villarroel.

The authors declare no competing interests.

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Vanegas Müller, E., Srikijkasemwat, N., Gan, A. et al. A systematic review of explainable artificial intelligence and cardiac electrophysiological models addressing sports-related sudden cardiac death and arrest in adolescents and young adults. npj Digit. Med. (2026). https://doi.org/10.1038/s41746-026-02878-x

DOI: https://doi.org/10.1038/s41746-026-02878-x