An Electrocardiogram Should Not Be Included in Routine Preparticipation Screening of Young Athletes

Abstract

The sudden death of a young athlete during competition is a tragic yet rare occurrence that results in significant public and media attention. Increased catecholamine response to maximum stress in subjects with underlying structural heart disease is a well-known cause of lethal cardiac arrhythmias.1 In 1996, the American Heart Association issued a scientific statement advocating universal cardiovascular preparticipation screening for high school and college athletes in an attempt to identify those at increased risk of cardiovascular events.2 The recommendations included a 12-point complete history and physical examination (including brachial artery blood pressure measurement) before competitive sports (Table 1) and reserved noninvasive testing such as a 12-lead ECG, echocardiogram, exercise testing, and cardiovascular consultation for athletes in whom any abnormality was detected. View this table: TABLE 1. The 12-Element AHA Recommendations for Preparticipation Cardiovascular Screening of Competitive Athletes Response by Myerburg and Vetter p 2615 The recommendations include repeat cardiovascular screening every 2 years with an abbreviated examination in intervening years. Parental participation in gathering a proper history in younger athletes was encouraged. The committee recommended a national standard for preparticipation cardiovascular medical evaluation and education of all healthcare providers who screen athletes because of the marked heterogeneity in the design and content of preparticipation cardiovascular screening and variable experience of healthcare screeners at the time. Routine diagnostic tests (ie, a 12-lead ECG) as part of the screening procedure were excluded primarily for cost-efficacy considerations. In the 2007 update,3 recently published in Circulation , the 12-point recommendations listed in Table 1 remain unchanged and do not include universal 12-lead ECG recordings as part of every preparticipation history and physical examination, unless, of course, the athlete fails the 12-point examination.3 The European Society of Cardiology (ESC) and the International Olympic Committee (IOC) screening questionnaires serve a purpose similar to that of …