Electrocardiographic screening in paediatric and adolescent athletes: a six-year experience from a swiss mass-participation race

Abstract Introduction Pre-participation cardiovascular screening with resting 12-lead electrocardiography (ECG) is recommended by most sports societies to detect conditions associated with sudden cardiac death (SCD). While the ideal age to initiate screening remains controversial, an expert consensus paper written in Switzerland suggested starting ECG screening at 15 years of age. As part of the Swiss multicentre prospective ECG screening study (Swiss PAED), we initiated an ECG screening program in 2018 in conjunction with the Course de l’Escalade, a popular running event attracting over 10’000 children and adolescents annually. Purpose The aim of this study is to evaluate the feasibility and diagnostic performance of resting 12-lead ECG screening in young competitive athletes aged 8–17 years participating in the Course de l’Escalade, and to determine the prevalence of normal, borderline, and abnormal ECG findings, including conditions associated with sudden cardiac death, using current international athlete-specific interpretation criteria. Method Athletes aged 8–17 years, training ≥6 hours per week in a squad and without known heart disease were invited to participate in the Course de l’Escalade screening program. Data collection included demographics, anthropometrics, sport type, training volume, medical history, blood pressure, heart rate, cardiac auscultation, and resting 12-lead ECG performed before or ≥1 hour after the race. ECGs were interpreted using the 2017 international recommendations for athletes and categorized as normal, borderline, or abnormal. Further investigations were undertaken when indicated. Results A total of 428 athletes (239 boys; mean age 12.9 ± 2.7 years) were enrolled. Normal variants were observed in 298/428 athletes (69.6%), most frequently sinus arrhythmia (183/428, 42.8%). Borderline findings in isolation occurred in 30/428 athletes (7.0%), most often right atrial enlargement (16/30, 3.7%). Abnormal findings were detected in 7/428 (1.6%) of athletes among whom 2/7 were subsequently found to have a condition associated with sudden cardiac death (Wolff–Parkinson–White WPW pattern in 2 athletes). Conclusion ECG-based screening during the Course de l’Escalade identified abnormal findings in 1.6% of young athletes among whom 2/7 were found to harbor diseases associated with sudden cardiac death (true positive ECG rate = 29%). Current international interpretation criteria performed well in this population of young competitive athletes.For image description, please refer to the figure legend and surrounding text.