Pre-participation screening in the young competitive athlete: International recommendations and a Canadian perspective

The sports medicine and cardiology communities have debated the role of screening ever since publication of a 25-year longitudinal study in Italy showed an 89% reduction in the rate of sudden cardiac death in young athletes after a cardiovascular screening program was implemented. Several consensus statements and research trials have been published on the effectiveness of screening young athletes, with the primary point of debate being whether the resting 12-lead electrocardiogram should be included, primarily due to concerns about false-positive rates and cost-effectiveness. Little research has come out of Canada on this topic, and to date no official recommendations have been developed for screening in this population. Pre-participation screening in the young competitive athlete: International recommendations and a Canadian perspective Although evidence supports the use of an electrocardiogram in cardiovascular screening programs for athletes, there are still concerns about feasibility and cost-effectiveness. Mr Lithwick is a project and research coordinator at SportsCardiologyBC and has completed a master’s degree in health administration at UBC. Dr Fordyce is a cardiology fellow at UBC. Ms Morrison is a project and research coordinator at SportsCardiologyBC and is completing a master’s degree in experimental medicine at UBC. Dr Nazzari is a resident in internal medicine at UBC. Ms Krikler is a research volunteer at SportsCardiologyBC and is completing her undergraduate degree at UBC. Dr Isserow is co-founder and medical director of SportsCardiologyBC and director of cardiology services at both UBC Hospital and the Centre for Cardiovascular Health at Vancouver General Hospital. Dr Heilbron is a cardiologist at SportsCardiologyBC and a clinical assistant professor in the Division of Cardiology at UBC. Dr Taunton is co-founder of SportsCardiologyBC and a professor in the Division of Sports Medicine at UBC. The sudden cardiac death (SCD) of a young athlete is typically the result of structural and ar­ rhythmic disorders that go undiag­ nosed, as the conditioned athlete typi­ cally doesn’t exhibit symptoms. As a result, medical organizations such as the American Heart Association (AHA) and the European Society of Cardiology (ESC) have published recommendations for the routine pre­participation screening of young competitive athletes. The AHA rec­ ommends cardiovascular screening for high school and college athletes before athletic participation and at 2­year to 4­year intervals thereafter. This initial screening consists of a cardiovascular­focused history and physical examination. The ESC en­ dorses routine pre­participation screening of athletes with a history and physical examination, but also recommends adding a resting 12­ lead electrocardiogram (ECG). The AHA’s rationale for not including an ECG are multifactorial and include concerns about false­positive results, cost­effectiveness, physician infra­ structure, and the feasibility of using health care resources for large­scale ECG screening. Currently, Canada has no official mandate or internationally recognized recommendations for pre­participation screening in young competitive athletes. This article has been peer reviewed.