Sudden cardiac death in athletes: what is the role of screening?

To briefly review the field of sudden cardiac death (SCD) in the athlete and the impact of preparticipation screening on identification of at-risk cardiovascular disorders and mortality reduction.

Competitive sports activity is associated with an increase in the risk of SCD in susceptible adolescents and young adults with clinically silent cardiovascular disorders. Screening including 12-lead electrocardiogram (ECG) has been demonstrated to allow identification of athletes affected by malignant heart muscle diseases at a presymptomatic stage and lead to substantial reduction of the risk of SCD during sports. The use of modern criteria for interpretation of the ECG in the athlete significantly improves the screening accuracy by reducing the false-positive rate (increased specificity), with the important requisite of maintaining the ability for detection of life-threatening heart diseases (preserved sensitivity). Screening including ECG has a more favourable cost-benefit ratio than that based on history and physical examination alone, with cost estimates per year of life saved below the threshold to consider a health intervention as cost-effective. Screening with exercise testing middle-aged/senior athletes engaged in leisure sports activity is likely to be cost-effective in older patients with coronary risk factors, while it is not justified in low-risk subgroups.

Preparticipation screening is a life-saving and cost-effective strategy in young athletes in whom SCD is mostly caused by ECG-detectable heart muscle diseases.