Screening ECGs for young competitive athletes: it is complicated

The role of the ECG in preparticipation sports screening for adolescent athletes is a major area of controversy today. Sudden cardiac death, especially in a young seemingly healthy individual, is a tragic and highly publicized event, which is often surrounded by cries from the public and medical community to 'do something.'

This emotional need to address these catastrophic events has led to over 4000 articles addressing the optimal way to screen the young athlete, as well as conflicting recommendations from the American Heart Association and the European Society of Cardiology, specifically in regards to inclusion of a screening ECG. This article will review the advances in the field over the last year, including the new guidelines on screening of the young athlete from the American Heart Association.

This last year has seen several important additions to the controversy surrounding the use of the 12-lead ECG in the screening of the young athlete. Although improved ECG criteria have decreased the prevalence of false positives, the actual utility of this practice has not been tested in real clinical practice outside of a formal investigation.