Sudden cardiac death (SCD) is a leading cause of death among athletes, and those with a positive family history (FH) of SCD and/or cardiovascular disease (CVD) may be at increased risk. The primary objective of this study was to assess the prevalence and predictors of positive FH of SCD and CVD in athletes using four widely used preparticipation screening (PPS) systems. The secondary objective was to compare the functionality of the screening systems. In a cohort of 13,876 athletes, 1.28% had a positive FH in at least one PPS system. Multivariate logistic regression analysis identified the maximum heart rate as significantly associated with positive FH (OR = 1.042, 95% CI = 1.027–1.056, p < 0.001). The highest prevalence of positive FH was found using the PPE-4 system (1.20%), followed by FIFA, AHA, and IOC systems (1.11%, 0.89%, and 0.71%, respectively). In conclusion, the prevalence of positive FH for SCD and CVD in Czech athletes was found to be 1.28%. Furthermore, positive FH was associated with a higher maximum heart rate at the peak of the exercise test. The findings of this study revealed significant differences in detection rates between PPS protocols, so further research is needed to determine the optimal method of FH collection.

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): IGA-internal grant agency Palacky University,Olomouc. Introduction Searching for a positive family history (FH) of cardiovascular disease (CVD) or sudden cardiac death (SCD) is a standard part of preparticipation screening (PPS) of athletes. This is despite the fact that there is no evidence to support either a mortality or cost-effective benefit of this practice. It is generally accepted that the use of a questionnaire method of family history investigation will expedite and refine the process of obtaining adequate responses required for the PPS. There are a number of PPS systems currently in use around the world, of which four standardized PPS systems are very commonly used (AHA; 5thPPE; IOC = Lausanne Questionnaire; FIFA), each with its own questionnaire that is distinct from the other systems. A positive finding of a family history of CVD/SCD in an athlete during PPS is an accepted indication for (sports) cardiology investigation. However, there is no evidence to define the scope of this examination and validate the mortality or cost-effective benefit of this practice. Purpose 1. To determine the number of athletes with positive FH in the entire cohort using questionnaires from the four PPS systems mentioned above. 2. Evaluate differences in frequency analysis of each questionnaire. 3. To identify question wording issues and to highlight overly "soft" criteria in each PPS system. 4. Propose optimization of FH data collection and follow-up. Methods and file Between 2015 and 6/2022, 14083 patients were screened at 2 centers. There were 13879 athletes with traceable FH (3768 females -27.1%), aged 14 (IQR 5) years. Results 180 athletes (1.3%) had positive FH according to at least one PPS system. The IOC system generated the fewest positive responses, followed by the AHA and FIFA, and the 5thPPE system clearly generated the most positive responses (by 80% compared to IOC). See Table 1. Clearly the "softest" question is the query about any heart disease/heart problems/ in 5thPPE, this alone is responsible for the majority of positive responses above the response levels of the other systems. Conclusion Investigating positive FH CVD/SCD is an established part of the athlete's PPS. There is up to 80% variation when using the 4 globally accepted PPS questionnaires. The lack of evidence for their use, as well as the lack of evidence for other cardiac retrospective investigations, coupled with their complexity and difficulty for patients to understand, is a challenge to research in this field.

Funding Acknowledgements Type of funding sources: None. Introduction The role of the arrhythmologist in a sports cardiology centre (SCC) is to provide comprehensive care to athletes with cardiac arrhythmias. Objective To determine the proportion of athletes with arrhythmias examined at a SCC. To define the differences in care between an athlete with and without arrhythmia. Methods Retrospective analysis of the registry of all athletes of one SCC. Identification of patients=athletes with arrhythmias, description of key differences in access to arrhythmology subunits. Cohort: Between 1/2020-6/2022, a total of 115 cases of athletes, 100 males and 15 females (13%), aged 26 (+/-11 years), were examined and definitively closed at SCC. Twenty-two athletes (19%) received care for cardiac rhythm disorders. Duration of sports activity was at the borderline of statistical significance in demographic parameters (see Table No. 1), with 15 (+/-11) vs 12 (+/-8) years for athletes with non-arrhythmic diagnoses (p=0.085). Results In the statistical comparison of the groups without and with arrhythmias (Table No. 2), we see a statistically significantly higher proportion of athletes presenting because of symptoms and with pathological findings of the pre-participation screening, with a higher proportion of family history of sudden cardiac death, with a higher proportion of coronary CT use and an extraordinary statistical significance of cardiac MRI use. Conversely, there is no statistically significant difference in diagnosis and impact on sports eligibility. The sports cardiologist must be particularly cautious in the diagnosis and treatment of ventricular extrasystoles, which have a different "diagnostic-eligibility" pathway for athletes. Similarly, they must listen to the medical history more than non-athletes and be willing and able to use various sports monitor records. In invasive methods of diagnosing and treating arrhythmias, it is necessary to understand when arrhythmias occur in real life and try to mimic the diagnostic conditions of this situation (e.g., when inducing clinical arrhythmias that an athlete has in real life during the peak moments of a match or race). Last but not least, the sports cardiologist must communicate the potential changes that may occur by ablative treatment of the arrhythmia (e.g., a decrease in maximal heart rate after AVNRT ablation on the so-called slow pathway, or, e.g. a possible increase in resting heart rate after pulmonary vein isolation with radiofrequency or laser energy). Conclusion Athletes with arrhythmias are different in many aspects, and the role of the arrhythmologist in the sports cardiology team is to be prepared to respect these differences in an effort to provide the best possible care for the athlete.

Funding Acknowledgements Type of funding sources: None. Introduction Cardiovascular care of highly active individuals and competitive athletes has become an important topic in the field of sports medicine. The evolving understanding of exercise-induced cardiovascular remodeling in athletes has led to a more thorough characterization of physiological adaptation versus pathological dysfunction, but this distinction is often challenging because of diagnostic commonalities. The current data reflect sport-specific analyses of predominantly male athletes that may not be readily applicable to the female athletic heart. Another aspect of this care may be the different approach to indication, interpretation, and referral between men and women. Objective To determine whether there is a difference between men and women in access to sports cardiac care. Whether there is a difference between the indicated investigations, therapeutic care and recommendations made. Methods Retrospective analysis of the registry of all athletes of the Sports Cardiology Centre (SCC). Statistical comparison of the cohort of women and men in all parameters studied. Cohort: Between 1/2020-6/2022, a total of 115 cases of athletes, 100 men and 15 women (13%), aged 26 (+/-11 years), were examined and definitively closed in the SCC. Demographics in Table No. 1. Results There were no statistically significant differences in indications, symptoms, examination methodologies, percentage of diagnosis or eligibility for sport from a cardiological perspective. The only statistically significant difference seen was in the higher percentage of women taking regular pharmacological medication (hormonal contraception was not included in this category) - namely 40% of women taking regular medication vs. 60% of women without medication vs. 85% of men without regular medication vs. 15% with regular medication (p=0.019). The differences in parameters across categories are summarized in Table No. 2. Conclusion Except for the total number of men and women screened, we do not see a significant difference in indication, screening, diagnosis and eligibility proposal between genders.