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Editorials

Sudden cardiac death in young athletes

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a309 (Published 03 July 2008) Cite this as: BMJ 2008;337:a309

The disputable role of exercise electrocardiography in preparticipation screening of young athletes

Drezner and Khan discuss in their editorial the article by Sofi et
al, the most recent report on the continuing debate on preparticipation
screening of young athletes to prevent sudden cardiac death (SCD).(1)(2)
In the report by Sofi et al. 153 of the 159 athletes were disqualified
from competitive sports because of cardiac abnormalities that would have
been overlooked on history and physical examination alone. Therefore they
conclude that adding resting electrocardiography (ECG) to the
preparticipation screening (PPS) is important, as pertinent in the
Lausanne Recommendations.(3)

However, it should be noted that among the 159 athletes, 126 (79.2%)
had a normal pattern on resting ECG. Thus, by not performing an exercise
ECG only 33 to 39 (dependent on an overlap between athletes indentified by
resting ECG and by history and physical examination) of the group
disqualified from competitive sports in the Sofi article would have been
indentified. For that reason Sofi et al. conclude that an exercise ECG can
show clear pathological findings in participants with negative or innocent
findings at physical examination and resting ECG.

Considering the described results, we would like to emphasize the
high yield of an exercise ECG in identifying athletes with relevant
cardiac abnormalities as a proxy for SCD, which in our opinion is somewhat
neglected in the editorial. Thus, these data can not be used to promote
baseline resting ECG as part of PPS, but should on the contrary be
regarded a plea for performing an exercise ECG. This plea, however, is not
yet supported by follow-up data on SCD, which is its weakness compared to
the earlier data on the effect of exclusion based on resting ECG
abnormalities.(4)

Similar to the debate on the role of a resting ECG in the PPS of
young athletes to prevent sudden cardiac death, factors as costs, the need
for expert evaluators and unknown false-positive and -negative rates make
adding exercise ECG to PPS disputable.

(1) Drezner JA, Khan K. Sudden cardiac death in young athletes. BMJ
2008; 337:a309.

(2) Sofi F, Capalbo A, Pucci N, Giuliattini J, Condino F, Alessandri
F et al. Cardiovascular evaluation, including resting and exercise
electrocardiography, before participation in competitive sports: cross
sectional study. BMJ 2008; 337:a346.

(3) Bille K, Figueiras D, Schamasch P, Kappenberger L, Brenner JI,
Meijboom FJ et al. Sudden cardiac death in athletes: the Lausanne
Recommendations. Eur J Cardiovasc Prev Rehabil 2006; 13(6):859-875.

(4) Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G.
Trends in sudden cardiovascular death in young competitive athletes after
implementation of a preparticipation screening program. JAMA 2006;
296(13):1593-1601.

Competing interests:
None declared

Competing interests: No competing interests

11 August 2008
Christian van der Werf
Research fellow Cardiology
Irene M. van Langen, clinical geneticist, Arthur A.M. Wilde, Professor of Cardiology
Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands