European Heart Journal Advance Access originally published online on February 2, 2005
European Heart Journal 2005 26(5):516-524; doi:10.1093/eurheartj/ehi108
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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
1Department of Cardiology, University of Padova, Italy
2Institute for Sports Sciences, Rome, Italy
3Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
4Cardiovascular Rehabilitation Unit, KU Leuven, Leuven, Belgium
5Department of Medicine, Sahlgrens University Hospital/Östra, Gothenburg, Sweden
6Department of Cardiology, Radboud University, Nijmegen, The Netherlands
7Sports Medicine, Aristotle University, Thessaloniki, Greece
8Klinikk Ullevål Sykehus, Oslo, Norway
9Wellness Medical Center, Stockport, UK
10Heart Center NRW, University Hospital, Bad Oeynhausen, Germany
11Department of Cardiology, University of Brescia, Italy
12Civil Hospital, Conegliano, Italy
13Division of Inherited Cardiovascular Diseases, University of Athens, Greece
14Department of Cardiology, University Hospital, Munich, Germany
15Molecular Cardiology, Fondazione S. Maugeri, Pavia, Italy
16Pathological Anatomy, University of Pavia, Italy
17Department of Cardiology, University Hospital Uppsala, Sweden
18Heart Hospital, University College London, UK
19Pathological Anatomy, University of Padova, Italy
Received 15 June 2004; revised 26 November 2004; accepted 9 December 2004; online publish-ahead-of-print 2 February 2005.
* Corresponding author: Department of Cardiology, Via Giustiniani, 2, 35121 Padova (Italy). Tel: +39 049 8212322; fax: +39 049 8212309. E-mail address: domenico.corrado{at}unipd.it
See page 428 for the editorial comment on this article (doi:10.1093/eurheartj/ehi154)
Abstract
The 1996 American Heart Association consensus panel recommendations stated that pre-participation cardiovascular screening for young competitive athletes is justifiable and compelling on ethical, legal, and medical grounds. The present article represents the consensus statement of the Study Group on Sports Cardiology of the Working Group on Cardiac Rehabilitation and Exercise Physiology and the Working Group on Myocardial and Pericardial diseases of the European Society of Cardiology, which comprises cardiovascular specialists and other physicians from different European countries with extensive clinical experience with young competitive athletes, as well as with pathological substrates of sudden death. The document takes note of the 25-year Italian experience on systematic pre-participation screening of competitive athletes and focuses on relevant issues, mostly regarding the relative risk, causes, and prevalence of sudden death in athletes; the efficacy, feasibility, and cost-effectiveness of population-based pre-participation cardiovascular screening; the key role of 12-lead ECG for identification of cardiovascular diseases such as cardiomyopathies and channelopathies at risk of sudden death during sports; and the potential of preventing fatal events. The main purpose of the consensus document is to reinforce the principle of the need for pre-participation medical clearance of all young athletes involved in organized sports programmes, on the basis of (i) the proven efficacy of systematic screening by 12-lead ECG (in addition to history and physical examination) to identify hypertrophic cardiomyopathy—the leading cause of sports-related sudden death—and to prevent athletic field fatalities; (ii) the potential screening ability in detecting other lethal cardiovascular diseases presenting with ECG abnormalities. The consensus document recommends the implementation of a common European screening protocol essentially based on 12-lead ECG.
Key Words: Athletes • Electrocardiogram • Screening • Sudden death
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