Cardiac evaluation of paediatric athletes

Area of Science:

• Cardiology
• Sports Medicine
• Paediatric Health

Background:

• Current cardiac screening guidelines for athletes are largely based on adult data, neglecting the unique physiology and risks in children.
• Paediatric athletes (<16 years) require tailored recommendations due to differences in cardiac maturation, disease expression, and training adaptations.

Purpose of the Study:

• To establish the first paediatric-specific cardiac screening recommendations for athletes, addressing age-related factors and ethical considerations.
• To provide expert consensus on screening strategies, diagnostic pathways, and eligibility for paediatric athletes.

Main Methods:

• Development of clinical consensus by the European Association of Preventive Cardiology (EAPC) and the Association for European Paediatric and Congenital Cardiology (AEPC).
• Anonymous voting by writing group members on key advice statements, requiring ≥80% agreement for consensus.
• Inclusion of data from paediatric athlete populations where available.

Main Results:

• Cardiac screening, including medical history, physical examination, and 12-lead resting electrocardiogram (ECG), is recommended for paediatric athletes, starting no later than age 12.
• Transthoracic echocardiography may be considered for identifying high-risk structural cardiac diseases not detected by ECG.
• Definitions for normal, borderline, and abnormal ECG findings in paediatric athletes are provided, along with guidance for further evaluation.

Conclusions:

• Paediatric athletes need distinct cardiac screening protocols distinct from adults.
• Implementation requires adequate healthcare resources and specialized training in paediatric sports cardiology.
• Further research is essential to refine screening, risk assessment for sudden cardiac death, and eligibility criteria.