Abstract des Autors

The incidence of sudden cardiac death (SCD) in young athletes has been estimated as low as 1:917,000 in high school athletes in the USA. However, the rate of SCD is significantly higher in certain young athlete populations, such as male college basketball players, where the rate has been reported as high as 1:5,200 athlete years. The wide range of SCD incidence is related to differences in study methodology and the accuracy of case capture and population estimates. In general, an accepted overall rate of SCD in young athletes in the USA is approximately 1:50,000–80,000 per year. To identify those at risk for catastrophic injury and death, young athletes in the USA undergo a pre-participation screening exam consisting of a history questionnaire and a physical exam. Since the publication of an Italian study demonstrating an 89% reduction in SCD coincident with implementing mandatory electrocardiogram (ECG) screening, physicians and researchers have debated the utility of including the screening ECG during the pre-participation exam for US athletes. Studies that did not predict or find an economic benefit of ECG screening programs in a region of Minnesota, that investigated SCD in athletes in Denmark, or Israel, or that broadened the Italian study from a specific population in Italy to the general population in the USA with no regard to risk factors have fueled the controversy. In spite of repeated findings that the currently endorsed pre-participation screening protocol by history and physical exam alone lacks both sensitivity and specificity for detecting potentially fatal cardiovascular conditions, both the American Heart Association (AHA) and the American College of Cardiology (ACC) continue to support this screening strategy and have opposed mandatory ECG screening for sports participation. While the AHA/ACC recommendations have not accounted for newer and stricter ECG interpretation criteria, they do support voluntary screening through community-based programs. The screening ECG has been found to be superior in both sensitivity and specificity to history and physical when performed by experienced clinicians. It also has some notable potential weaknesses pertaining to (1) accurate interpretation and the rate of false positives and unnecessary secondary testing, (2) cost-effectiveness, and (3) psychological implications of temporary or permanent restriction from competition. Given that the rate of SCD can be up to 3.6 times more likely in competitive athletes than nonathletes, and that robust data support that certain athlete groups are at substantially higher risk, the authors believe that ECG screening in targeted high-risk groups should be strongly considered when proper ECG interpretation and cardiology resources are available and we present an argument to support the appropriate inclusion of the screening ECG during the pre-participation exam. Criticisms such as logistics and economics have been addressed repeatedly in the literature and require careful consideration as summarized below.