Cardiac evaluation of paediatric athletes
Guido PielesElena CavarrettaJessica J OrchardM AbelaElena ArbeloWerner BudtsSilvia CastellettiGuido ClaessenDomenico CorradoGiovanni Di SalvoGherardo FinocchiaroPeter FritschSabiha GatiStephan GerlingM Cecilia Gonzalez-CorciaAneil MalhotraV MaestriniJosef NiebauerDavid NiederseerMichael PapadakisR OberhofferAntonio PellicciaNathan R RidingM Sanz-De La GarzaGeorgia Sarquella-BrugadaSonal SharmaAlan Graham StuartMonica TiberiAlessandro ZorziFlavio D’Ascenzi
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Why the study?
Most existing recommendations for cardiac screening in paediatric athletes are based on adult evidence and designed for adults, necessitating paediatric-specific recommendations.
Key Points
- To establish specific cardiac evaluation recommendations for paediatric athletes based on their unique physiological needs.
- Consensus document based on expert opinion from the EAPC and AEPC.
- Recommends cardiac screening protocols including personal and family medical history, physical examination, and ECG.
- Includes guidelines for interpreting ECG findings and further evaluations.
- At least 80% agreement on key recommendations for cardiac screening.
- Screening to begin by age 12, incorporating ECG and possibly echocardiogram as needed.
- Identification of further research needs to optimize screening and assess risk of sudden cardiac death.
Structured PICO
P
Population
Paediatric athletes aged <16 years, including those under 12 years of age
I
Intervention
Cardiac screening including personal and family medical history, physical examination, 12-lead resting ECG, and potentially one transthoracic echocardiogram
This consensus document provides the first specific recommendations for cardiac screening in paediatric athletes under 16 years of age, advising history, physical exam, and ECG starting no later than age 12.
Limitations
- Further research is required to optimise screening strategies, accurately assess and quantify the risk of sudden cardiac death and provide evidence-based eligibility recommendations.
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This clinical consensus document from the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC) introduces specific advice for paediatric athletes for the first time, based on expert consensus, and where available, data from paediatric athlete populations.”
“The article, 'Cardiac evaluation of paediatric athletes', provides, for the first time, specific, consensus-based recommendations for cardiovascular screening in young athletes—addressing a critical gap in current practice. Key highlights include: The need for age-specific screening strategies, recognizing that paediatric athletes are not simply 'mini adults'. Recommendations for ECG-based screening starting no later than age 12. Practical guidance on distinguishing physiological adaptations from potential pathology. This important work contributes to improving early detection of cardiovascular risk, supporting safer sports participation, and advancing paediatric sports cardiology worldwide.”
MAMark AbelaSports cardiologist, Army Cardiologist, FESC FACC
“Very happy to share our latest joint EAPC/AEPC statement 'Cardiac evaluation of paediatric athletes'.”
Implication
Paediatric athletes warrant screening by age 12; extends consensus to this gap population and leaves open outcome validation.
Abstract
Paediatric athletes are not simply ‘mini adults’. Most existing recommendations for cardiac screening in paediatric athletes are primarily based on evidence in adults and are designed for adult athletes. Paediatric-specific recommendations are needed due to the specifics of cardiac physiology, maturation and growth, age-related disease expression, modified diagnostic pathways, training adaptations, and to address relevant ethical considerations. This clinical consensus document from the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC) introduces specific advice for paediatric athletes for the first time, based on expert consensus, and where available, data from paediatric athlete populations. Members of the writing group voted anonymously on key advice statements, with ≥80% agreement required for consensus. All advice in this document applies to paediatric athletes aged <16 years, including those under 12 years of age. This document advises that cardiac screening of paediatric athletes with personal and family medical history, physical examination and 12-lead resting electrocardiogram (ECG) should be performed and should start no later than the age of 12 years. Implementing a screening programme requires ensuring the availability of necessary healthcare resources. One transthoracic echocardiogram may be appropriate to identify high-risk structural cardiac diseases not identifiable on ECG, provided appropriate infrastructure for baseline diagnostic assessments is in place. This document also includes suggested definitions of normal, borderline and abnormal ECG findings in paediatric athletes. Detailed advice is provided for further evaluation if suspicious findings are identified on initial tests. This document highlights that further research is required to optimise screening strategies, accurately assess and quantify the risk of sudden cardiac death and provide evidence-based eligibility recommendations for paediatric athletes with cardiac disease. It is also noted that increased opportunities for paediatric sports cardiology training are required to provide adequate medical care for the paediatric athlete population.
Cite This Study
Pieles et al. (2026) conducted a review in Cardiac screening in paediatric athletes. Cardiac screening (history, physical examination, 12-lead resting ECG) was evaluated. This expert consensus document advises that cardiac screening of paediatric athletes with history, physical examination, and 12-lead resting ECG should start no later than 12 years of age.