https://www.theguardian.com/sport/2018/apr/09/michael-goolae...
Often there are warnings, like arythmias which I guess can be signs the electrical functions aren't great. Those sorts of congenital defects are hard to detect, acknowledge and treat seriously as a condition.
aka "sudden death syndrome"
Some people have heart defects that leave them susceptible to instant surprise heart failure.
A notable case is a college basketball player a few years ago who literally just died running across the court.
My wife has this!
According to the ROC:
Approximately 356,461 people in the US experienced an out-of-hospital cardiac arrest (347,922 adults, 7,037 children under age 18)
22,520 of those 356,461 were witnessed by bystanders
12.4% survived to hospital discharge
Of the EMS patients who experienced non-traumatic cardiac arrest outside a hospital, and did not have bystander intervention, 10.8% survived until hospital discharge
[999] - https://www.aedsuperstore.com/resources/sudden-cardiac-arres...
For example, http://www.sca-aware.org/sca-news/aha-releases-2015-heart-an... says that the incidence is 0.24 per 100k annually for high school athletes in Minnesota. Extrapolating that rate to the whole US population would give ~800 deaths per year. The observed 400k number includes quite a lot of people who suffer cardiac arrest after a history of heart disease.