Which screening strategy should be used to identify young athletes at risk for sudden cardiac death is a highly controversial matter. For many years the medical community has disputed the cost effectiveness, feasibility, and accuracy of including 12 lead electrocardiography in the cardiovascular screening of athletes. Discordant recommendations from the American Heart Association and the European Society of Cardiology have fuelled a global debate about the usefulness of such screening in athletes.1 2 In the linked study, Sofi and colleagues analyse data from 30 065 Italian athletes who underwent a complete pre-participation cardiovascular evaluation including resting and exercise electrocardiography.3

Sudden cardiac death in young athletes (<35 years) is caused by a diverse set of structural diseases of the heart (such as cardiomyopathies) and electrical defects (such as ion channelopathies). In the United States alone, one young competitive athlete dies every three days from an unrecognised cardiovascular disorder.4 American and European authorities have recommended a comprehensive pre-participation evaluation, which includes a detailed patient and family history and a physical examination, in all athletes of 12 years or more.1 2

Warning symptoms of underlying …