Pre-participation evaluation of Malaysian university athletes – the importance of cardiovascular screening

Background: Sudden cardiac arrest and death (SCA/D) remains the leading cause of mortality among athletes. Contemporary standards of identifying normal physiological cardiac adaptations and remodeling from regular athletic training based on certain ECG morphology have been clearly defined by the ‘Seattle Criteria’ in 2012, with an updated ‘International Consensus’ in 2017. In heterogenous Asia, regional SCA/D preponderance data is still lacking. This study aims to report on the detection of potentially dangerous cardiovascular conditions in Malaysian university athletes via pre-participation evaluation.Methods: 176 Malaysian athletes competing in the 18th ASEAN University Games 2016 were requested to attend a centralised pre-participation evaluation (PPE) prior to the games. The PPE included history, physical examination and a resting ECG. Participating sports and the corresponding number of athletes were athletics (40), basketball (26), football (24), silat (16), rugby (14), badminton (14), table tennis (12), shooting (12), fencing (10) and petanque (8).Results: 113 athletes (64.2%) attended and completed the PPE. The highest percentages of athletes screened were from shooting, fencing and petanque (100% respectively), whilst the lowest were from the basketball team (23.1%). Three abnormal ECGs were identified: a multiple premature ventricular contractions, an atrial tachyarrhythmia and a ventricular pre-excitation. These three athletes were referred for subsequent investigations of which two were allowed to return to play. The latter athlete was diagnosed with Wolff-Parkinson-White syndrome and was advised against competing until definitive management was instituted. Conclusion: Only a fair number of Malaysian university athletes completed the medical screening, and hence are possibly unaware of the importance of PPE. Despite our small sample size, we picked up three cases requiring further investigation and interventional studies. No screening program provides absolute protection against death. Thus, more evidence-based research and constant update in best practice guidelines are vital to foster safe sports participation and ultimately reduce incidence of SCA/D in the athletic population. Athletes need to be aware and give full cooperation for PPE to ensure timely detection of high risk cardiovascular conditions especially those related to sudden death in sports.