Can electrocardiographic screening prevent sudden death in athletes? No

Some facts are undisputed. Every year, athletes die tragically during exercise. Although regular physical activity is beneficial for most, vigorous exercise transiently increases the risk of sudden cardiac death in people with underlying cardiovascular disease—for example, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, ion channelopathies, or coronary artery anomalies.1 Sudden death during exercise is often the first manifestation of heart disease.2 Screening with 12-lead electrocardiography can identify some people with underlying heart disease.3 4

Proponents argue that these facts support making electrocardiographic screening a prerequisite for participation in organised sports to prevent sudden death.5 The cornerstone of their argument is a 25 year prospective study (1979-2004) from the Veneto region in Italy. This showed that the introduction of a mandatory screening programme for all athletes aged between 12 and 35 who wanted to participate in organised sports reduced the annual incidence of sudden cardiac deaths among athletes by 89%, while the incidence for non-athletic people of the same age remained unchanged. The main explanation was that athletes with cardiomyopathies were screened …