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Echocardiography is used to confirm hypertrophic subaortic cardiomyopathy
6%
97/1505
History and physical examination are considered more cost-effective than EKG for screening
8%
126/1505
Athletes with a family history of sudden cardiac death should receive additional testing
5%
77/1505
Electrocardiography will result in a large number of false-positive results
19%
285/1505
Electrocardiography cannot detect potential causes for sudden cardiac death
61%
911/1505
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There are several reasons why electrocardiology (EKG) is not used for routine pre-participation screening in US high school athletes, but it is not because it cannot detect some of the potential causes for sudden cardiac death- it can. The major causes of sudden death in a young competitive athlete include hypertrophic cardiomyopathy, myocarditis, coronary abnormalities, and conduction abnormalities. The goal of pre-participation screening is to identify athletes who are at increased risk for cardiovascular events on the field. According to the American Heart Association,“a complete and careful personal and family history and physical examination designed to identify (or raise suspicion of) those cardiovascular lesions known to cause sudden death or disease progression in young athletes is the best available and most practical approach to screening populations of competitive sports participants, regardless of age.” Noninvasive testing such as electrocardiography (EKG), echocardiography (Echo), and stress tests can be used to detect some potential causes for sudden cardiac death. However, it is not recommended as a routine screening procedure in young athletes from a cost-benefit standpoint. O'Connor et al noted that mass EKG testing would be a costly method to identify athletes with cardiac abnormalities, with 98.8% of the costs going to work-up of false positives. They note that effectiveness of EKG screening could be improved by testing only those athletes who are at high risk for harboring cardiac abnormalities capable of causing sudden cardiac death, ie. those with risk factors based on history or physical. Corrado et al published a decrease in sudden death in one region of Italy where EKG was added to routine screening for all young athletes. However, when this was evaluated by Maron et al, sudden death was only decreased to the same level (or slightly higher) than that of a comparable US population without the use of EKG screening. They felt that the data did not support a lower mortality with the routine EKG screening and added that up to 30% of these events likely would not be detected on routine EKG.
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