Preparticipation Athletic Screening Including an Electrocardiogram: An Unproven Strategy for Prevention of Sudden Cardiac Death in the Athlete

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Abstract

One of the fundamental principles of evidence-based medicine is that clinical practice should be based on evidence derived from sufficiently robust data to ensure that the benefits, risks, and costs of an intervention are known. Although intuitively appealing, athletic screening programs with routine electrocardiograms (ECGs) followed by restriction of at-risk individuals have not been demonstrated to be effective in decreasing the inherent risk of athletic sudden death. The incremental use of a screening ECG to a history and physical examination remains debatable because of insufficient evidence to conclusively resolve the issue. Long-term outcomes with a large group of athletes undergoing screening and restriction are limited to a small number of observational trials. One supports and many do not support ECG screening with athletic restriction of at-risk athletes. Although programs and policies to decrease sudden death are laudable, they need further evaluation before being implemented on a large-scale basis. Currently, athletes are best protected by a strategy of secondary prevention with improvements in resuscitation and emergency action plans.

Section snippets

Case report

A 17-year-old asymptomatic male hockey player had athletic preparticipation screening with an unremarkable history and examination. His electrocardiogram (ECG), included as part of routine screening, demonstrated an incomplete right bundle-brunch block (RBBB) with secondary repolarization changes. He was referred by the team doctor, a family medicine physician, to a local cardiologist who performed another history, examination, and ECG. An echocardiogram performed showed borderline right

Conclusion

One major objective of preparticipation athletic screening is detection of potentially lethal cardiovascular diseases likely to manifest with SCD during athletics. However, identification of a potentially lethal disease is important only if an effective preventive strategy reduces the risk of SCD.19 Subsequent intervention in a fashion that unequivocally improves outcomes is another important objective.19 The optimal strategy for advancing toward the widely accepted goal of prevention of sudden

Statement of Conflict of Interest

All authors declare that there are no conflicts of interest.

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    Statement of Conflict of Interest: see page 454.

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