Pros and cons of screening for sudden cardiac death in sports

Sudden cardiac death (SCD) in the athlete, though uncommon, is the most devastating sport related event. It is widely publicised by the news media with the implication that such a fatality is preventable. The previous year of 2012 was notorious for SCD during sports. Several tragic events occurred in top level athletes—including a 25-year-old Italian soccer player, a 26-year-old Norwegian swimmer, a 24-year-old Serbian rower, and a 32-year-old runner in the London marathon. In addition, the 23-year-old soccer player Fabrice Muamba experienced an on-pitch aborted SCD during an English FA Cup match. These events have revived the debate regarding the need for a preparticipation cardiovascular evaluation of athletes and the inclusion of a 12 lead ECG in the screening protocol. This article aims to review the field of SCD in the athlete, to highlight the areas of controversy on preparticipation screening, to address the opposing points of view in a balanced way, and to clarify which questions still remain unanswered.