ECG screening to prevent sudden cardiac death on the sports field: Is there now evidence supporting such practice?
DOI:
https://doi.org/10.14288/hfjc.v8i3.193Keywords:
Bayes theorem, Cardiac anomalies, Cardiac arrhythmias, Cardiac emergencies, Safety, Sensitivity, SpecificityAbstract
Objective. Occasional incidents of sudden death on the sports field have provoked conflicting views on risk reduction through pre-participation screening. Some sports physicians call simply for a thorough clinical examination, but others insist that this must be coupled with a resting ECG examination. Debate has been particularly vigorous in the past ten years; the present article briefly recapitulates earlier arguments and seeks an appropriate, evidence-based current recommendation.
Methods. Ovid/Medline, PubMed, Google Scholar and personal files were searched for articles related to ECG screening and sudden, exercise-related cardiac death, with particular reference to publications appearing in the past 10 years.
Results. The introduction of mandatory ECG screening in Italy in 1982 was justified after the fact by a drop in sudden deaths from an unusually high level in the year before the law was enacted to a level typical of North American during the subsequent decade. The criteria used in screening were not athlete-specific, and false positives excluded many potential competitors from play. Moreover, compulsory screening that began in Israel in 1979 had no effect upon the incidence of sudden death. Attempts to develop athlete-specific ECG norms have developed at least 4 options, all rated against clinical judgments rather than their success in identifying those later succumbing to sudden, exercise-related death. The low incidence of such events militates against the setting of criteria that will not have an excessive false positive rate; indeed, some recent authors query whether sudden death is indeed more common in athletes than in the sedentary population.
Conclusions. Randomized trials examining the consequences of ECG screening and subsequent restriction of physical activity are needed, and the merits of this approach must be compared with a stronger emphasis upon secondary prevention and emergency preparedness. But at present ECG screening still lacks the sensitivity and specifity to be an effective tool in reducing the risk of SERCD.
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