Physical activity confers important cardiovascular health benefits although intensive exercise may increase the cardiac arrest risk. With the increasing tennis popularity, its practice may be considered at risk but this association remains unclear.

To estimate the incidence of tennis-related cardiac arrests and measure its proportion among all sports-related cardiac arrests.

An electronic search of several databases was conducted (from 1948 to April 29, 2019) for studies having analyzed cardiac arrest during tennis practice. Two independent reviewers selected and extracted data from eligible studies. Using a random-effects model, annual incidence rate per million individuals and 95% CIs were calculated as well as the proportion of tennis-related cardiac arrests among all sports-related cardiac arrests. Heterogeneity among studies was evaluated with the I² statistics and publication biais with the Egger's test P-value.

WE included 8 studies from 3continents involving 3885 cardiac arrests during sports of which 56tennis-related cardiac arrests. Inter-rater agreements were very high (kappa=0,88 for the first selection step from title and abstract and kappa=1 for the second selection step from entire article). The annual incidence rate of tennis-related cardiac arrests was 0.044 per million [0.021–0.068], P<10⁻³ (N studies=8, I²=0%, Egger's test P-value<10⁻⁴). This incidence varied from 0.035 [0–0.070] among young competitive athletes in both sexes to 0.046 [0–0.092] in elderly men during recreational tennis practice. The proportion of tennis-related cardiac arrests among all sports-related cardiac arrests was 1.8% [0.8%–2.9%], P=0.001 (N studies=7) (Fig. 1).

Tennis-related cardiac arrest incidence is very small worlwide and its proportion is very low among all sports-related cardiac arrests. Thus, these results highlight the health benefits of the tennis among the general population with a low-risk of cardiac arrest.