ECG screening in athletes: differing views from two sides of the Atlantic

### Learning objectives The death of any young person is a devastating event, and the death of a young athlete, apparently in the peak of health, even more so. While not common, occurring in 1–2 per 100 000 athletes per year,1 these events are reported in the media and can feel devastating to the whole community. Approximately half of sudden deaths in athletes are due to cardiovascular causes,2 3 As shown in figure 1, different studies have shown different results regarding most frequent aetiologies of sudden death in athletes. Early studies suggested hypertrophic cardiomyopathy (HCM) to be the most frequent cause.2 More recent studies have described the plurality of athlete sudden deaths as ‘autopsy negative', suggesting channelopathies, which cannot be diagnosed through anatomic autopsy, may be more common.4–6 Regardless of specific breakdown, HCM, long QT syndrome, other cardiomyopathies and channelopathies, anomalous coronary arteries and aortic disease underlie the bulk of cases of sudden cardiac death (SCD) in the athlete. Figure 1 Aetiologies of sudden cardiac death in athletes. Comparison of pathogeneses of sudden cardiac death. Reprinted with permission from Harmon  et al. 6 ARVC, arrhythmogenic cardiomyopathy; CM, cardiomyopathy; HCM, hypertrophic cardiomyopathy; LVH, left ventricular hypertrophy; MI, myocardial infarction; NCAA, National Collegiate Athletic Association; SCT, sickle cell trait; SUD, sudden unexplained death. How best to prevent these tragic events is a matter of intense debate in both the USA and Europe. Most efforts have focused on identification of those at risk through preparticipation evaluation (PPE, or screening) either through history and physical (H&P) or through H&P combined with ECG. Currently, many professional sporting organisations including the International Olympic Committee mandate or recommend ECG screening.7 The US National Collegiate Athletic Association (NCAA) …