Electrocardiographic screening in paediatric and adolescent athletes: a 6-year prospective observational study from a Swiss mass-participation race

Pre-participation cardiovascular screening with resting 12-lead electrocardiography (ECG) is recommended by most sports societies to detect conditions associated with sudden cardiac death. While the ideal age to initiate screening remains controversial, an expert consensus paper written in Switzerland suggested starting ECG screening at 15 years of age. As part of the Swiss multicentre prospective ECG screening study (Swiss PAED), we initiated an ECG screening programme in 2018 in conjunction with the Course de l'Escalade, a popular Geneva running event attracting over 10,000 children and adolescents annually.

This prospective observational study was conducted between 2018 and 2024 (excluding 2020 due to the COVID-19 pandemic) during the Course de l'Escalade in Geneva, Switzerland. Competitive athletes aged 8-17 years training ≥6 hours per week in organised sport and without known cardiac disease were invited to undergo pre-participation cardiovascular evaluation including medical history, physical examination and resting 12-lead ECG. ECGs were interpreted according to the 2017 international criteria for athlete ECG interpretation and classified as normal, borderline or abnormal. Abnormal ECGs were referred for specialist cardiology evaluation.

A total of 428 athletes (239 boys; mean age 12.9 [2.7] years) were enrolled. Normal variants were observed in 298/428 athletes (69.6%), most frequently sinus arrhythmia (183/428, 42.8%). Borderline findings in isolation occurred in 30/428 athletes (7.0%), most often right atrial enlargement (16/30, 3.7%). Abnormal findings were detected in 7/428 (1.6%) athletes, among whom 2/7 were subsequently found to have a condition associated with sudden cardiac death: Wolff-Parkinson-White pattern.

ECG-based screening during the Course de l'Escalade identified abnormal findings in 1.6% of young athletes among whom 2/7 were found to harbour a disease associated with sudden cardiac death. Current international interpretation criteria performed well in this population of young competitive athletes.