ECG as a part of the preparticipation screening programme: an old and still present international dilemma

Abstract

Given the ability of 12-lead ECG to detect individuals with structural heart disease, we suggest its inclusion as a part of preparticipation screening programmes.

Incidence of Sudden Cardiac Death in National Collegiate Athletic Association Athletes

“…4 The present study has profound implications for both primary and secondary prevention strategies. ECG screening is effective in detecting 66% to 100% of silent cardiovascular diseases in athletes, [17][18][19][20][21] with a false-positive rate of 2% to 5% when contemporary standards for ECG interpretation are used. 21,29 Cost-effectiveness calculations for the inclusion of an ECG in the preparticipation screening of athletes will differ significantly depending on the incidence rate used.…”

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)

“…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. 3,105 This has become a highly visible and vigorously debated topic, because the SD risk associated with intense physical activity (in the setting of potentially life-threatening but occult cardiovascular disease) potentially could be modified by withdrawal from a competitive athletic lifestyle 18 and could even be preventable in high-risk patients by prophylactic treatment interventions (eg, implantable cardioverter-defibrillators).…”

“…173 This often becomes a dilemma for examiners, given that the vast majority of such individuals are likely to be unaffected, and the finding will be benign. Although the 12-lead ECG can be regarded as more sensitive than the history and physical, 91,98,104,172 it is nevertheless associated with reduced specificity because of falsepositive results. 17,24,25,55,64,65,88,91 However, the acknowledged insensitivity of the history and physical examination screening cannot be considered a major justification for mass screening of general populations with ECGs.…”

Preparticipation Screening of Young Athletes: Why Still Open Questions on Performing an Electrocardiogram?

“…Male gender has been considered an additional independent prognosticator, likely due to high-intensity training and greater prevalence of genotype-positive pathways for cardiomyopathies [1][2][3][4][5][6][7][8][9].…”

“…Despite the rarity of this event, eligibility of athletes with potentially lethal cardiovascular disease is still debated [1,2,[4][5][6][7].…”