Hypertrophic cardiomyopathy is considered a principal cause of sudden unexpected cardiac death in young athletes. However, a number of demographic features observed in these deaths are not consistent with the diagnosis. All of these characteristics instead share in common a propensity for ventricular hypertrophy, implying that these deaths may reflect electrical stability in the extremely rare athlete with exaggerated myocardial hypertrophy in response to sports training. This review provides an evidence-based line of reasoning that supports this concept.