Sudden cardiac death during sport and recreational activities in Israel

Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age)

“…Most of these come from Italian investigators (n=19) and others (n=14), who suggest that the ECG is a reliable and economically feasible diagnostic test, some prematurely pronouncing a paradigm shift, 49,78 whereas others appear contradictory 49,85 ; other statements have come from an American Heart Association (AHA) science advisory 87 and a report from the National Institutes of Health. 23 Indeed, the issue of preparticipation athlete screening for cardiovascular disease has become the subject of discussion in a number of countries, including the United States,* Italy, 4,18,31 Israel, 28,29,31,92,93 Germany, 94 Sweden, 95 the United Kingdom, 60,96 China, 97 the Netherlands, 98 France, 99 Norway, 58 Denmark, 5,100 Japan, 101,102 Switzerland, 103 and Spain. 104 The present discussion defines cardiovascular screening as an initiative intended to prospectively identify or raise suspicion of previously unrecognized and largely genetic or congenital cardiovascular diseases known to cause sudden cardiac arrest and SD in young people.…”

“…113,237 Often ignored in this discussion is the importance of falsenegative test results in the ECGs, which reflect low sensitivity. 93,97,125,127,189,190 In the current environment, false-negative results can be expected in ≥10% of patients with HCM (the most common cause of SD in young people), with a significant proportion of these showing completely normal patterns. 189 In addition, ≥90% of those with congenital coronary anomalies (the second most common cause of SD in young athletes) will have a normal ECG.…”

“…28,93 The Israeli Sport Law, enacted in 1997, defines athletes requiring screening as those "individuals engaged in sport activities at any level of physical endurance," from amateur sportsmen to professional athletes. 246 The law also dictates that only physicians certified by a specialized accreditation course can perform screening examinations.…”

“…The United States has not enacted any legislation similar to the national laws of countries such as Italy 4,18,116,244 and Israel, 28,29,92,93,246 both of which require use of a 12-lead ECG as part of mandatory preparticipation screening to identify cardiovascular disease in all people desiring to participate in organized competitive athletics. The laws of these 2 countries, even when combined with several European countries' voluntary adoption of the International Olympic Committee recommendation that an ECG be part of cardiovascular screening for Olympic athletes, do not conclusively establish an international standard or custom to require use of a 12-lead ECG in mass screening of large populations of young people for cardiovascular abnormalities.…”

Sudden cardiac death in athletes: An overview

“…Estimates vary depending on the population studied (eg, college athletes, athletes in general) and are hampered by a lack of well-conducted prospective studies. Generally speaking, SCD occurs in 1 athlete per 100,000 per year, with a striking male predominance (male-female ratio, 10:1), and increases with age [4][5][6][7][8][9].…”