Key result
Pre-participation ECG screening linked to ~90% lower SCD rates in young competitive athletes vs unscreened populations.
Why the study?
Although pre-participation screening lowers sudden cardiac death rates in athletes, no universal protocol exists and challenges persist, including overlapping physiological remodeling, underrepresented subgroups, and the need for cost-effective implementation.
Does pre-participation screening including 12-lead ECG prevent sudden cardiac death in competitive athletes?
Does pre-participation screening including 12-lead ECG prevent sudden cardiac death in competitive athletes?
Effect estimate: ~90% reduction in SCD rate after implementation of ECG-based PPS in Veneto region, Italy
Pre-participation screening with 12-lead ECG is effective in identifying athletes at risk for sudden cardiac death, but requires refined interpretation criteria and secondary prevention measures to optimize outcomes and cost-effectiveness.
Supports ECG-inclusive screening in athletes; leaves open need for RCTs to confirm generalizability and causality.
Pre-participation screening (PPS) is a primary‐prevention strategy used in competitive sports to identify athletes at risk for cardiac diseases that can present with malignant arrhythmias and sudden cardiac death (SCD). Although compelling evidence supports the ability of PPS to lower SCD rates among athletes, no universal protocol has been adopted. Over time, however, key elements have emerged as common denominators: medical history, physical examination, and a 12-lead electrocardiogram (ECG). Research on ECG interpretation continues to evolve in search of the most accurate criteria for detecting cardiac disease, yet significant challenges persist. A major difficulty is the overlap between physiological remodeling in well-trained hearts and early manifestations of cardiomyopathy. In addition, some subgroups (female athletes, master athletes, and pediatric athletes) remain underrepresented in current studies. To ensure broad and equitable implementation, PPS must be supported by public-health policies and recognized as cost-effective, with the expectation that early identification of at-risk individuals will ultimately reduce the burden of advanced treatments on healthcare systems. Achieving this goal requires improving the sensitivity and specificity of existing screening tools to minimize misdiagnosis and avoid unnecessary secondary investigations or unwarranted disqualification from competition. This review summarizes the current status of cardiac screening in athletes, highlights persistent challenges, and outlines future directions to enhance its effectiveness and long-term sustainability.
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Graziano et al. (2026) conducted a review in risk of sudden cardiac death in athletes. Pre-participation screening including 12-lead ECG vs. Screening by history and physical examination only was evaluated on Incidence of sudden cardiac death among young competitive athletes (~90% reduction in SCD rate after implementation of ECG-based PPS in Veneto region, Italy). Pre-participation cardiac screening including 12-lead ECG reduced sudden cardiac death in young competitive athletes by approximately 90% compared to unscreened populations, as observed in Veneto, Italy.
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