Athletes Should Be Screened For Heart Abnormalities To Prevent Sudden Death

Young athletes should be routinely tested for heart abnormalities to prevent sudden cardiac death that is triggered by vigorous exercise, using a simple protocol, which includes a heart trace (electrocardiogram or ECG).


This is the conclusion of several studies in the first of a series of quarterly partnership issues between the British Journal of Sports Medicine and the International Olympic Committee (IOC), which are dedicated to injury prevention in elite sports.


Sudden cardiac death is the leading cause of death in young athletes, but exactly how common it is, is unknown as figures vary considerably and there is no mandatory reporting.


Screening for silent but potentially deadly heart abnormalities in athletes before they embark on a career in competitive sports, known as preparticipation cardiovascular screening or PPS for short, has been the subject of considerable debate.


This was re-ignited in 2005, with the publication of a common European protocol - the Lausanne recommendations - which advocate taking a personal and medical history, a physical examination, and an ECG for every young competitive athlete.


But critics claim that there are too many population differences between countries for these recommendations to be universally relevant, and that ECGs pick up too many 'normal irregularities' induced by the body's adaptation to the demands of competitive sports - sparking unnecessary alarm and needless investigations.


Opponents have also cast doubt on the cost effectiveness of this check.


But the findings of Dutch researchers published in this special issue, go some way to answering the critics.


The researchers applied the recommendations to 371 athletes between the ages of 12 and 35 over a period of two years, and they found that their findings echoed previous research, spanning 25 years, carried out on Italian athletes.



The results showed that ECG produced false positive results for 47 athletes (11%), which is an acceptable rate, and picked up problems in a further 10 (2%), of whom four were restricted from further participation in sport.


The number of screens needed to pick up one athlete with potentially lethal cardiovascular disease was 143, which is well within acceptable limits for any screening programme, say the authors.


In another review of the available evidence, British researchers confirm that trying to pick up potentially fatal heart abnormalities through questionnaires and physical exam alone is not very effective.



The use of defribillators at an event is not a viable alternative either, because the survival rate is so low, the research shows.


If a cardiologist carries out an ECG check, the false positive rate can be as low as 2%, and a well organised national programme would be cost effective, they argue, "especially when considering the devastating effect of a sudden death in a young athlete."


The Lausanne recommendations have already been endorsed by the football governing bodies, and the Union of European Football Associations also advocates mandatory screening of all players participating in European championships.


"Healthcare governing bodies need to be convinced that now is the time for universal ECG screening of all young athletes and make the necessary provisions for nationwide screening programmes to commence," conclude the authors.


Link to Dutch research

Link to British review

Link to Editorial



Source
British Journal Of Sports Medicine

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