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Sudden cardiac death (SCD) in the athlete, though uncommon, is the most devastating sport related event. It is widely publicised by the news media with the implication that such a fatality is preventable. The previous year of 2012 was notorious for SCD during sports. Several tragic events occurred in top level athletes—including a 25-year-old Italian soccer player, a 26-year-old Norwegian swimmer, a 24-year-old Serbian rower, and a 32-year-old runner in the London marathon. In addition, the 23-year-old soccer player Fabrice Muamba experienced an on-pitch aborted SCD during an English FA Cup match. These events have revived the debate regarding the need for a preparticipation cardiovascular evaluation of athletes and the inclusion of a 12 lead ECG in the screening protocol.
This article aims to review the field of SCD in the athlete, to highlight the areas of controversy on preparticipation screening, to address the opposing points of view in a balanced way, and to clarify which questions still remain unanswered.
Criteria for considering appropriate any public health screening programme
In the 1960s the World Health Organization adopted the criteria for evaluating public health screening measures which were set out by Wilson and Jungner.1 According to these criteria, a public health screening programme is justifiable when: (1) the condition to be detected is of public health importance; (2) there is an effective test for detecting the condition at a sufficiently early stage to permit intervention; (3) there are available effective treatments for the condition when it is detected at an early stage; (4) there is evidence that early treatment, before onset of symptoms, leads to better outcomes; and (5) the screening programme is feasible in a cost effective manner.
Accordingly, systematic screening of athletes for preventing SCD would be justified if: (1) cardiovascular diseases at risk are sufficiently common to warrant the screening efforts; (2) tests to distinguish athletes …