ECG screening in athletes: differing views from two sides of the Atlantic

Impact of early sports specialisation on paediatric ECG

“…In the debate of ECG inclusion in pre-participation screening of athletes, there is criticism because of insufficient sensitivity and specificity as well as lack of definitive outcome data and costs of additional exams. 37 As stated above, the International Criteria for ECG Interpretation in Athletes decisively improved the sensitivity and specificity of ECG as a screening tool for athletes. Regarding our cohort, they seem to perform well in a pediatric population reducing the need for further evaluation.…”

“…On the other hand, the low prevalence of abnormal findings (2.1%) did not generate a large number of additional examinations and all athletes were cleared for participation without the need for invasive procedures. In the debate of ECG inclusion in pre‐participation screening of athletes, there is criticism because of insufficient sensitivity and specificity as well as lack of definitive outcome data and costs of additional exams 37 . As stated above, the International Criteria for ECG Interpretation in Athletes decisively improved the sensitivity and specificity of ECG as a screening tool for athletes.…”

Canadian Cardiovascular Society/Canadian Heart Rhythm Society Joint Position Statement on the Cardiovascular Screening of Competitive Athletes

“…1 The 12-lead ECG International guidelines differ in their recommendations addressing ECG screening of competitive athletes. 24 The resting 12-lead ECG is superior to the history and physical examination in the detection of disease associated with SCD. 13 Factors considered in recommending ECGs are: (1) detection of subclinical asymptomatic electrophysiological disease such as Wolff-Parkinson-White, some channelopathies, and occult cardiomyopathies such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy (ARVC) 24 ; (2) the fact that most athletes who succumb to SCD are asymptomatic; and (3) the low percentage of deaths that are readily identifiable using physical examination.…”

“…24 The resting 12-lead ECG is superior to the history and physical examination in the detection of disease associated with SCD. 13 Factors considered in recommending ECGs are: (1) detection of subclinical asymptomatic electrophysiological disease such as Wolff-Parkinson-White, some channelopathies, and occult cardiomyopathies such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy (ARVC) 24 ; (2) the fact that most athletes who succumb to SCD are asymptomatic; and (3) the low percentage of deaths that are readily identifiable using physical examination. 13,18 The utility of an ECG to improve detection is influenced by the underlying prevalence of disease predisposing to SCD specifically during sport (which is very challenging to determine), the sensitivity of the ECG in young athletes, and the experience of its reader.…”

Heartbeat: socioeconomic deprivation is associated with non-cardiovascular mortality in chronic heart failure patients

“…The Education in Heart article discusses the causes of sudden death and recommendations for ECG screening for heart disease in athletes 6. You can listen to a short summary and discussion of this article in a podcast with James Rudd interviewing Dr Andrew D’Silva from Brighton, UK, one of the authors of the article.…”