Abstract

The storied history of sport has often been marred by dreadful tragedies. Athletes in their relentless pursuit of perfection suffer horrific insult, the worst being sudden death on the field of play. The prevalence of cardiovascular conditions predisposing to sudden death has recently been estimated to be 1 in 333 athletes. In light of this finding the importance of instituting an appropriate screening program cannot be overstated. Discussion: Sudden cardiac death (SCD) is often the first and only manifestation of underlying cardiovascular conditions. While most sporting federations agree that athletes should undergo pre-participation screening, exact guidelines have not been standardized. The American Heart Association advocates a detailed medical history and physical to identify athletes at risk of SCD while the European Society of Cardiology and the International Olympic Committee recommend the additional use of electrocardiograms (ECG) for effective screening. Numerous studies including a prospective study involving almost 40,000 athletes in the Veneto region of Italy demonstrated a reduction in the incidence of SCD by almost 90% with the use of ECGs as an adjunct to a suitable history and physical. Arguments against the use of ECGs revolve around feasibility and a high rate of false-positives resulting in unnecessary restriction from sport. While these considerations are legitimate and indeed important, recent literature including that from the Italian experience demonstrates that interpretation of ECGs based on newly-established sport-specific criteria leads to an acceptable decrease in the rate of false positive. In addition to primary prevention, due attention must also be given to secondary prevention including the presence of trained medical personnel and defibrillators at all sporting venues. Conclusions: In light of the current evidence it would be prudent for sports administrators to revisit the issue of athlete safety and institute universal guidelines regarding the screening of athletes and secondary prevention.