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Heart, Lung and Circulation

New International Guidelines for the Interpretation of the Electrocardiograph in Athletes: a “Traffic Light” Tool for Maximising Diagnostic Specificity

      While sudden cardiac death (SCD) is devastating in all age groups, the death of a young athlete, especially those with a popular reputation or during a high-profile sporting event, is greatly magnified in the media. The incidence of sudden death in young athletes (≤35 years of age) is approximately 0.6–3.6 per 100,000 population per year, and most deaths are due to cardiovascular causes [
      • Corrado D.
      • Basso C.
      • Pavei A.
      • Michieli P.
      • Schiavon M.
      • Thiene G.
      Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program.
      ,
      • Corrado D.
      • Basso C.
      • Rizzoli G.
      • Schiavon M.
      • Thiene G.
      Does sports activity enhance the risk of sudden death in adolescents and young adults?.
      ,
      • Maron B.J.
      • Doerer J.J.
      • Haas T.S.
      • Tierney D.M.
      • Mueller F.O.
      Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006.
      ]. The cardiovascular screening of competitive athletes is mandated in some countries and recommended in others. Screening comprises a history and examination in the USA, while the addition of a 12-lead electrocardiograph (ECG) is recommended in most other countries and also by sporting bodies, such as the International Olympics Committee and the International bodies representing cycling, rowing, tennis and swimming, among others [
      • Maron B.J.
      • Thompson P.D.
      • Ackerman M.J.
      • Balady G.
      • Berger S.
      • Cohen D.
      • et al.
      Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation.
      ,
      • Corrado D.
      • Pelliccia A.
      • Bjornstad H.H.
      • Vanhees L.
      • Biffi A.
      • Borjesson M.
      • et al.
      Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology.
      ]. The aim of screening is to identify cardiomyopathies and channelopathies that may be asymptomatic but represent a potential trigger for exercise-related deaths. The most common underlying aetiology varies between reports from different countries; primary causes are hypertrophic cardiomyopathy (HCM; dominant in United States cohort [
      • Maron B.J.
      • Doerer J.J.
      • Haas T.S.
      • Tierney D.M.
      • Mueller F.O.
      Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006.
      ,
      • de Noronha S.V.
      • Sharma S.
      • Papadakis M.
      • Desai S.
      • Whyte G.
      • Sheppard M.N.
      Aetiology of sudden cardiac death in athletes in the United Kingdom: a pathological study.
      ]) or idiopathic left ventricular hypertrophy [
      • de Noronha S.V.
      • Sharma S.
      • Papadakis M.
      • Desai S.
      • Whyte G.
      • Sheppard M.N.
      Aetiology of sudden cardiac death in athletes in the United Kingdom: a pathological study.
      ], arrhythmogenic right ventricular dysplasia (ARVC; dominant in Italian cohort [
      • Corrado D.
      • Basso C.
      • Rizzoli G.
      • Schiavon M.
      • Thiene G.
      Does sports activity enhance the risk of sudden death in adolescents and young adults?.
      ]), dilated cardiomyopathy, myocarditis, channelopathies in the presence of a structural normal heart [
      • Harmon K.G.
      • Drezner J.A.
      • Maleszewski J.J.
      • Lopez-Anderson M.
      • Owens D.
      • Prutkin J.M.
      • et al.
      Pathogeneses of sudden cardiac death in national collegiate athletic association athletes.
      ], aortic dissection and coronary artery disease (including coronary anomalies) [
      • de Noronha S.V.
      • Sharma S.
      • Papadakis M.
      • Desai S.
      • Whyte G.
      • Sheppard M.N.
      Aetiology of sudden cardiac death in athletes in the United Kingdom: a pathological study.
      ].
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