Some Common Ground Emerges in Debate Over ECGs for Athletes.

Abstract

Benjamin Levine, MD, sports cardiologist at University of Texas Southwestern Medical Center and a long-time critic of the universal use of ECGs for athlete preparticipation physical examination, recently took an unusual step. He recruited academics and advocates of wider ECG screening to participate in a pilot randomized trial comparing American Heart Association–recommended preparticipation screening with this screening plus ECG. The hope is that the study may provide evidence needed to help answer one of the most persistent and vexing questions in sports cardiology: Do the benefits of adding ECGs to preparticipation screening outweigh the risks? Proponents of wider ECG screening argue such screening could save lives. Some advocates, including parents who have lost children to sudden cardiac death during athletics, have pushed for laws at the state level that would require ECGs to be included in sports physicals. But critics like Levine, director of the Institute for Exercise and Environmental Medicine run by University of Texas Southwestern and Texas Health Resources, argue that such additional screening may not save lives and could cause harm to otherwise healthy individuals. Now, both sides are finding some common ground. There is growing consensus that those reviewing athlete ECGs need to be appropriately skilled and have resources in place for downstream care. There is also growing recognition of the potential value of screening those at highest risk of sudden cardiac death. Better training for those who read young athletes’ ECG is needed, experts say. Preparticipation health screening for athletes, including a physical examination and personal and family history, is recommended by the American Heart Association and the National Collegiate Athletic Association. Critics of these screening protocols argue that they are not adequate, and multiple studies …