Preparticipation cardiovascular screening in young athletes: current guidelines and dilemmas

How to best screen athletes for conditions predisposing to sudden cardiac death is a topic of debate. The European Society of Cardiology and International Olympic Committee recently endorsed a standardized screening evaluation modeled after the successful Italian system, which utilizes a 12-lead electrocardiogram (ECG) along with a detailed history and physical exam. The ECG increases the power of the history and physical exam to detect underlying causes of sudden cardiac death. In 2007, the American Heart Association (AHA) panel recommended against implementation of such a system in the United States because of a lack of current infrastructure, providers, and expertise. The lack of standardization of the current cardiovascular screening system in the United States hinders its effectiveness and prevents systematic evaluation. The AHA strongly recommends establishing a national standard for cardiovascular screening as well as a certification process for non-physicians who perform screening exams. Well designed studies are needed in the U.S. to demonstrate the effectiveness of the ECG for identifying underlying cardiovascular abnormalities in young athletes.