ESC criteria for ECG interpretation in athletes: better but not perfect
- Department of Cardiac and Vascular Sciences. St George's University of London, London, UK
- Correspondence to Professor Sanjay Sharma, Department of Cardiovascular Sciences, St George's University of London, Cranmer Terrace, London SW17 0RE, UK; ssharma21{at}hotmail.com
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Contributors SS, SG and MP drafted the article and revised it critically for scientific content, and approved the final version for publication.
- Cardiomyopathy dilated
- screening
- left ventricular hypertrophy
- sudden adult death syndrome
- cardiomyopathy restrictive
- arrhythmogenic right ventricular dyplasia
- brugada
- channelopathy
- cardiomyopathy hypertrophic
The sudden cardiac death (SCD) of an apparently healthy young person (<35 years) has a devastating impact on the family and peers. Poignant newspaper articles and video footage showing the athletic prowess of the youth, apparent epitome of health and circumstantial paradox send ripples of emotion within the lay community. Over 80% of all exercise-related SCDs in young athletes are attributed to inherited or congenital cardiovascular disorders.1 2
Most causes of SCD are identifiable during life and several therapeutic strategies are available to minimise the risk of a SCD. Whereas most health professionals are staunch advocates of protecting young athletes on humanitarian grounds, the feasibility of implementing preparticipation screening (PPS) for cardiac disease specifically is frequently met with resistance and remains a heavily debated subject. The low incidence of SCD in sport (1 in 50 000) and need for multiple investigations to identify all implicated disorder raise issues pertinent to cost-effectiveness and are a persistent ‘Achilles heel’ for proponents of PPS. Furthermore, athletic training is associated with electrocardiographic patterns that may resemble those seen in patients with incomplete or morphologically mild expressions of primary cardiomyopathies and ion channelopathies. These false-positive results raise concerns about unnecessary investigations, erroneous disqualification and psychological harm to the athlete. Conversely, SCDs in sport are highly visible, claiming young lives.3
There is general agreement that a form of cost-effective PPS should be implemented; however, the precise methodology is contested. Most European countries do not offer state-sponsored PPS. In the USA, the American Heart Association implemented a PPS programme in 1996 to identify serious cardiovascular disorders in high school and intercollegiate athletes through a 12-point health questionnaire and physical examination.4 The American approach appears …
