Screening young athletes for prevention of sudden cardiac death: Practical recommendations for sports physicians

Scandinavian Journal of Medicine and Science in Sports

Volumn 26, Issue 4, 2016, Pages 362-374

  Chatard, J C ^a   Mujika, I ^b,c   Goiriena, J J ^b   Carre F ^d  

^a UNIVERSITÉ JEAN MONNET   (France)

^b UNIVERSITY OF THE BASQUE COUNTRY UPV EHU   (Spain)

^c UNIVERSIDAD FINIS TERRAE   (Chile)

^d UNIVERSITÉ DE RENNES 1   (France)

Author keywords

Black athlete; Cardiomyopathy; Echocardiography; Electrocardiogram; Pre participation screening

Indexed keywords

ADOLESCENT; ADULT; ATHLETE; CHILD; DEATH, SUDDEN, CARDIAC; ELECTROCARDIOGRAPHY; EXERCISE; FEMALE; HEART DISEASES; HUMAN; INCIDENCE; ITALY; MALE; PHYSICAL EXAMINATION; PROCEDURES; QUESTIONNAIRE; SPORTS MEDICINE; UNITED STATES; YOUNG ADULT;

ADOLESCENT; ADULT; ATHLETES; CHILD; DEATH, SUDDEN, CARDIAC; ELECTROCARDIOGRAPHY; EXERCISE; FEMALE; HEART DISEASES; HUMANS; INCIDENCE; ITALY; MALE; PHYSICAL EXAMINATION; SPORTS MEDICINE; SURVEYS AND QUESTIONNAIRES; UNITED STATES; YOUNG ADULT;

EID: 84961202847     PISSN: 09057188     EISSN: 16000838     Source Type: Journal    
DOI: 10.1111/sms.12502     Document Type: Article

References (76)

1. Baggish AL, Hutter AM Jr, Wang F, Yared K, Weiner RB, Kupperman E, Picard MH, Wood MJ. Cardiovascular screening in college athletes with and without electrocardiography: a cross-sectional study. Ann Intern Med 2010: 152: 269-275.
2. Basavarajaiah S, Wilson M, Whyte G, Shah A, McKenna W, Sharma S. Prevalence of hypertrophic cardiomyopathy in highly trained athletes: relevance to pre-participation screening. J Am Coll Cardiol 2008: 51: 1033-1039.
3. Battle RW, Mistry DJ, Malhotra R, Macknight JM, Saliba EN, Mahapatra S. Cardiovascular screening and the elite athlete: advances, concepts, controversies, and a view of the future. Clin Sports Med 2011: 30: 503-524.
4. Berdowski J, de Beus MF, Blom M, Bardai A, Bots ML, Doevendans PA, Grobbee DE, Tan HL, Tijssen JG, Koster RW, Mosterd A. Exercise-related out-of-hospital cardiac arrest in the general population: incidence and prognosis. Eur Heart J 2013: 34: 3616-3623.
5. Bille K, Figueiras D, Schamasch P, Kappenberger L, Brenner JI, Meijboom FJ, Meijboom EJ. Sudden cardiac death in athletes: the Lausanne Recommendations. Eur J Cardiovasc Prev Rehabil 2006: 13: 859-875.
6. Borjesson M, Dellborg M. Is there evidence for mandating electrocardiogram as part of the pre-participation examination? Clin J Sport Med 2011: 21: 13-17.
7. Carré F, Brion R, Douard H, Marcadet D, Leenhardt A, Marcon F, Lusson JR. Recommandations concernat le contenu du bilan cardio-vasculaire de la visite de non contre indication à la pratique du sport en compétition entre 12 et 35 ans. Arch Cardiovasc Dis 2009: 182: 41-43.
8. Chan RH, Maron BJ, Olivotto I, Pencina MJ, Assenza GE, Haas T, Lesser JR, Gruner C, Crean AM, Rakowski H, Udelson JE, Rowin E, Lombardi M, Cecchi F, Tomberli B, Spirito P, Formisano F, Biagini E, Rapezzi C, De Cecco CN, Autore C, Cook EF, Hong SN, Gibson CM, Manning WJ, Appelbaum E, Maron MS. Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evaluation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation 2014: 130: 484-495.
9. Chandra N, Bastiaenen R, Papadakis M, Panoulas VF, Ghani S, Duschl J, Foldes D, Raju H, Osborne R, Sharma S. The prevalence of ECG anomalies in young individuals; relevance to a nationwide cardiac screening program. J Am Coll Cardiol 2014: 63: 2028-2034.
10. Chandra N, Papadakis M, Sharma S. Cardiac adaptation in athletes of black ethnicity: differentiating pathology from physiology. Heart 2012: 98: 1194-1200.
11. Charron P. Genetic analysis for predictive screening in hypertrophic cardiomyopathy. Heart 2012: 98: 603-604.
12. Chevalier L, Hajjar M, Douard H, Cherief A, Dindard JM, Sedze F, Ricard R, Vincent MP, Corneloup L, Gencel L, Carre F. Sports-related acute cardiovascular events in a general population: a French prospective study. Eur J Cardiovasc Prev Rehabil 2009: 16: 365-370.
13. Cirino AL, Ho CY. Genetic testing for inherited heart disease. Circulation 2013: 128: e4-e8.
14. Colbert JA. Clinical decisions. Cardiac screening before participation in sports - polling results. N Engl J Med 2014: 370: e16.
15. Corrado D, Basso C, Schiavon M, Thiene G. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med 1998: 339: 364-369.
16. Corrado D, Calore C, Zorzi A, Migliore F. Improving the interpretation of the athlete's electrocardiogram. Eur Heart J 2013: 34: 3606-3609.
17. Corrado D, McKenna WJ. Appropriate interpretation of the athlete's electrocardiogram saves lives as well as money. Eur Heart J 2007: 28: 1920-1922.
18. Corrado D, Pelliccia A, Bjornstad HH, Vanhees L, Biffi A, Borjesson M, Panhuyzen-Goedkoop N, Deligiannis A, Solberg E, Dugmore D, Mellwig KP, Assanelli D, Delise P, van Buuren F, Anastasakis A, Heidbuchel H, Hoffmann E, Fagard R, Priori SG, Basso C, Arbustini E, Blomstrom-Lundqvist C, McKenna WJ, Thiene G. 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. Eur Heart J 2005: 26: 516-524.
19. Corrado D, Pelliccia A, Heidbuchel H, Sharma S, Link M, Basso C, Biffi A, Buja G, Delise P, Gussac I, Anastasakis A, Borjesson M, Bjornstad HH, Carre F, Deligiannis A, Dugmore D, Fagard R, Hoogsteen J, Mellwig KP, Panhuyzen-Goedkoop N, Solberg E, Vanhees L, Drezner J, Estes NA 3rd, Iliceto S, Maron BJ, Peidro R, Schwartz PJ, Stein R, Thiene G, Zeppilli P, McKenna WJ. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J 2010: 31: 243-259.
20. Corrado D, Schmied C, Basso C, Borjesson M, Schiavon M, Pelliccia A, Vanhees L, Thiene G. Risk of sports: do we need a pre-participation screening for competitive and leisure athletes? Eur Heart J 2011: 32: 934-944.
21. Drezner JA. Standardised criteria for ECG interpretation in athletes: a practical tool. Br J Sports Med 2012: 46 (Suppl. 1): i6-i8.
22. Drezner JA, Ackerman MJ, Anderson J, Ashley E, Asplund CA, Baggish AL, Borjesson M, Cannon BC, Corrado D, DiFiori JP, Fischbach P, Froelicher V, Harmon KG, Heidbuchel H, Marek J, Owens DS, Paul S, Pelliccia A, Prutkin JM, Salerno JC, Schmied CM, Sharma S, Stein R, Vetter VL, Wilson MG. Electrocardiographic interpretation in athletes: the "Seattle criteria". Br J Sports Med 2013a: 47: 122-124.
23. Drezner JA, Ackerman MJ, Cannon BC, Corrado D, Heidbuchel H, Prutkin JM, Salerno JC, Anderson J, Ashley E, Asplund CA, Baggish AL, Borjesson M, DiFiori JP, Fischbach P, Froelicher V, Harmon KG, Marek J, Owens DS, Paul S, Pelliccia A, Schmied CM, Sharma S, Stein R, Vetter VL, Wilson MG. Abnormal electrocardiographic findings in athletes: recognising changes suggestive of primary electrical disease. Br J Sports Med 2013b: 47: 153-167.
24. Drezner JA, Ashley E, Baggish AL, Borjesson M, Corrado D, Owens DS, Patel A, Pelliccia A, Vetter VL, Ackerman MJ, Anderson J, Asplund CA, Cannon BC, DiFiori J, Fischbach P, Froelicher V, Harmon KG, Heidbuchel H, Marek J, Paul S, Prutkin JM, Salerno JC, Schmied CM, Sharma S, Stein R, Wilson M. Abnormal electrocardiographic findings in athletes: recognising changes suggestive of cardiomyopathy. Br J Sports Med 2013c: 47: 137-152.
25. Drezner JA, Asif IM, Owens DS, Prutkin JM, Salerno JC, Fean R, Rao AL, Stout K, Harmon KG. Accuracy of ECG interpretation in competitive athletes: the impact of using standardised ECG criteria. Br J Sports Med 2012a: 46: 335-340.
26. Drezner JA, Fischbach P, Froelicher V, Marek J, Pelliccia A, Prutkin JM, Schmied CM, Sharma S, Wilson MG, Ackerman MJ, Anderson J, Ashley E, Asplund CA, Baggish AL, Borjesson M, Cannon BC, Corrado D, DiFiori JP, Harmon KG, Heidbuchel H, Owens DS, Paul S, Salerno JC, Stein R, Vetter VL. Normal electrocardiographic findings: recognising physiological adaptations in athletes. Br J Sports Med 2013d: 47: 125-136.
27. Drezner JA, Fudge J, Harmon KG, Berger S, Campbell RM, Vetter VL. Warning symptoms and family history in children and young adults with sudden cardiac arrest. J Am Board Fam Med 2012b: 25: 408-415.
28. Elliott PM, Poloniecki J, Dickie S, Sharma S, Monserrat L, Varnava A, Mahon NG, McKenna WJ. Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. J Am Coll Cardiol 2000: 36: 2212-2218.
29. Exeter DJ, Elley CR, Fulcher ML, Lee AC, Drezner JA, Asif IM. Standardised criteria improve accuracy of ECG interpretation in competitive athletes: a randomised controlled trial. Br J Sports Med 2014: 48: 1167-1171.
30. Fuller CM, McNulty CM, Spring DA, Arger KM, Bruce SS, Chryssos BE, Drummer EM, Kelley FP, Newmark MJ, Whipple GH. Prospective screening of 5, 615 high school athletes for risk of sudden cardiac death. Med Sci Sports Exerc 1997: 29: 1131-1138.
31. Gati S, Sheikh N, Ghani S, Zaidi A, Wilson M, Raju H, Cox A, Reed M, Papadakis M, Sharma S. Should axis deviation or atrial enlargement be categorised as abnormal in young athletes? The athlete's electrocardiogram: time for re-appraisal of markers of pathology. Eur Heart J 2013: 34: 3641-3648.
32. Halkin A, Steinvil A, Rosso R, Adler A, Rozovski U, Viskin S. Preventing sudden death of athletes with electrocardiographic screening: what is the absolute benefit and how much will it cost? J Am Coll Cardiol 2012: 60: 2271-2276.
33. Harmon KG, Asif IM, Klossner D, Drezner JA. Incidence of sudden cardiac death in National Collegiate Athletic Association athletes. Circulation 2011: 123: 1594-1600.
34. Harmon KG, Drezner JA, Wilson MG, Sharma S. Incidence of sudden cardiac death in athletes: a state-of-the-art review. Br J Sports Med 2014: 48: 1185-1192.
35. Hevia AC, Fernandez MM, Palacio JM, Martin EH, Castro MG, Reguero JJ. ECG as a part of the preparticipation screening programme: an old and still present international dilemma. Br J Sports Med 2011: 45: 776-779.
36. Holst AG, Winkel BG, Theilade J, Kristensen IB, Thomsen JL, Ottesen GL, Svendsen JH, Haunso S, Prescott E, Tfelt-Hansen J. Incidence and etiology of sports-related sudden cardiac death in Denmark - implications for preparticipation screening. Heart Rhythm 2010: 7: 1365-1371.
37. Luijkx T, Velthuis BK, Prakken NH, Cox MG, Bots ML, Mali WP, Hauer RN, Cramer MJ. Impact of revised Task Force Criteria: distinguishing the athlete's heart from ARVC/D using cardiac magnetic resonance imaging. Eur J Prev Cardiol 2012: 19: 885-891.
38. Magalski A, Maron BJ, Main ML, McCoy M, Florez A, Reid KJ, Epps HW, Bates J, Browne JE. Relation of race to electrocardiographic patterns in elite American football players. J Am Coll Cardiol 2008: 51: 2250-2255.
39. Malhotra R, West JJ, Dent J, Luna M, Kramer CM, Mounsey JP, Battle R, Saliba E, Rose B, Mistry D, MacKnight J, DiMarco JP, Mahapatra S. Cost and yield of adding electrocardiography to history and physical in screening Division I intercollegiate athletes: a 5-year experience. Heart Rhythm 2011: 8: 721-727.
40. Mangold S, Kramer U, Franzen E, Erz G, Bretschneider C, Seeger A, Claussen CD, Niess AM, Burgstahler C. Detection of cardiovascular disease in elite athletes using cardiac magnetic resonance imaging. Rofo 2013: 185: 1167-1174.
41. Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, Calkins H, Corrado D, Cox MG, Daubert JP, Fontaine G, Gear K, Hauer R, Nava A, Picard MH, Protonotarios N, Saffitz JE, Sanborn DM, Steinberg JS, Tandri H, Thiene G, Towbin JA, Tsatsopoulou A, Wichter T, Zareba W. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task Force Criteria. Eur Heart J 2010: 31: 806-814.
42. Marijon E, Tafflet M, Celermajer DS, Dumas F, Perier MC, Mustafic H, Toussaint JF, Desnos M, Rieu M, Benameur N, Le Heuzey JY, Empana JP, Jouven X. Sports-related sudden death in the general population. Circulation 2011: 124: 672-681.
43. Maron BJ. Counterpoint/mandatory ECG screening of young competitive athletes. Heart Rhythm 2012: 9: 1897.
44. Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation 2009: 119: 1085-1092.
45. Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, Okin PM, Saul JP, Salberg L, Van Hare GF, Soliman EZ, Chen J, Matherne GP, Bolling SF, Mitten MJ, Caplan A, Balady GJ, Thompson PD. Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): a scientific statement from the American Heart Association and the American College of Cardiology. Circulation 2014a: 130: 1303-1334.
46. Maron BJ, Haas TS, Murphy CJ, Ahluwalia A, Rutten-Ramos S. Incidence and causes of sudden death in U.S. college athletes. J Am Coll Cardiol 2014b: 63: 1636-1643.
47. Maron BJ, Shirani J, Poliac LC, Mathenge R, Roberts WC, Mueller FO. Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA 1996: 276: 199-204.
48. Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D, Dimeff R, Douglas PS, Glover DW, Hutter AM Jr, Krauss MD, Maron MS, Mitten MJ, Roberts WO, Puffer JC. 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. Circulation 2007: 115: 1643-1645.
49. Mayer F, Bonaventura K, Cassel M, Mueller S, Weber J, Scharhag-Rosenberger F, Carlsohn A, Baur H, Scharhag J. Medical results of preparticipation examination in adolescent athletes. Br J Sports Med 2012: 46: 524-530.
50. Menafoglio A, Di Valentino M, Segatto JM, Siragusa P, Pezzoli R, Maggi M, Romano GA, Moschovitis G, Wilhelm M, Gallino A. Costs and yield of a 15-month preparticipation cardiovascular examination with ECG in 1070 young athletes in Switzerland: implications for routine ECG screening. Br J Sports Med 2014: 48: 1157-1161.
51. Moon JC, Reed E, Sheppard MN, Elkington AG, Ho SY, Burke M, Petrou M, Pennell DJ. The histologic basis of late gadolinium enhancement cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J Am Coll Cardiol 2004: 43: 2260-2264.
52. Myerburg RJ, Vetter VL. Electrocardiograms should be included in preparticipation screening of athletes. Circulation 2007: 116: 2616-2626.
53. Papadakis M, Carre F, Kervio G, Rawlins J, Panoulas VF, Chandra N, Basavarajaiah S, Carby L, Fonseca T, Sharma S. The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin. Eur Heart J 2011: 32: 2304-2313.
54. Pappone C, Vicedomini G, Manguso F, Saviano M, Baldi M, Pappone A, Ciaccio C, Giannelli L, Ionescu B, Petretta A, Vitale R, Cuko A, Calovic Z, Fundaliotis A, Moscatiello M, Tavazzi L, Santinelli V. Wolff-Parkinson-White syndrome in the era of catheter ablation: insights from a registry study of 2169 patients. Circulation 2014: 130: 811-819.
55. Pelliccia A, Di Paolo FM, Quattrini FM, Basso C, Culasso F, Popoli G, De Luca R, Spataro A, Biffi A, Thiene G, Maron BJ. Outcomes in athletes with marked ECG repolarization abnormalities. N Engl J Med 2008: 358: 152-161.
56. Pelliccia A, Maron BJ, Culasso F, Di Paolo FM, Spataro A, Biffi A, Caselli G, Piovano P. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 2000: 102: 278-284.
57. Postema PG, De Jong JS, Van der Bilt IA, Wilde AA. Accurate electrocardiographic assessment of the QT interval: teach the tangent. Heart Rhythm 2008: 5: 1015-1018.
58. Price DE, McWilliams A, Asif IM, Martin A, Elliott SD, Dulin M, Drezner JA. Electrocardiography-inclusive screening strategies for detection of cardiovascular abnormalities in high school athletes. Heart Rhythm 2014: 11: 442-449.
59. Rawlins J, Carre F, Kervio G, Papadakis M, Chandra N, Edwards C, Whyte GP, Sharma S. Ethnic differences in physiological cardiac adaptation to intense physical exercise in highly trained female athletes. Circulation 2010: 121: 1078-1085.
60. Rowin EJ, Maron BJ, Appelbaum E, Link MS, Gibson CM, Lesser JR, Haas TS, Udelson JE, Manning WJ, Maron MS. Significance of false negative electrocardiograms in preparticipation screening of athletes for hypertrophic cardiomyopathy. Am J Cardiol 2012: 110: 1027-1032.
61. Schnell F, Riding N, O'Hanlon R, Axel Lentz P, Donal E, Kervio G, Matelot D, Leurent G, Doutreleau S, Chevalier L, Guerard S, Wilson MG, Carre F. Recognition and significance of pathological T-wave inversions in athletes. Circulation 2015: 131: 165-173.
62. Sharma S. Point/mandatory ECG screening of young competitive athletes. Heart Rhythm 2012: 9: 1896.
63. Sharma S, Elliott P, Whyte G, Jones S, Mahon N, Whipp B, McKenna WJ. Utility of cardiopulmonary exercise in the assessment of clinical determinants of functional capacity in hypertrophic cardiomyopathy. Am J Cardiol 2000: 86: 162-168.
64. Sheikh N, Papadakis M, Ghani S, Zaidi A, Gati S, Adami PE, Carre F, Schnell F, Wilson M, Avila P, McKenna W, Sharma S. Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes. Circulation 2014: 129: 1637-1649.
65. Shephard RJ. Mandatory ECG screening of athletes: is this question now resolved? Sports Med 2011: 41: 989-1002.
66. Shimizu W, Kamakura S. Catecholamines in children with congenital long QT syndrome and Brugada syndrome. J Electrocardiol 2001: 34 (Suppl.): 173-175.
67. Steinvil A, Chundadze T, Zeltser D, Rogowski O, Halkin A, Galily Y, Perluk H, Viskin S. Mandatory electrocardiographic screening of athletes to reduce their risk for sudden death proven fact or wishful thinking? J Am Coll Cardiol 2011: 57: 1291-1296.
68. Toresdahl BG, Rao AL, Harmon KG, Drezner JA. Incidence of sudden cardiac arrest in high school student athletes on school campus. Heart Rhythm 2014: 11: 1190-1194.
69. Uberoi A, Stein R, Perez MV, Freeman J, Wheeler M, Dewey F, Peidro R, Hadley D, Drezner J, Sharma S, Pelliccia A, Corrado D, Niebauer J, Estes NA 3rd, Ashley E, Froelicher V. Interpretation of the electrocardiogram of young athletes. Circulation 2011: 124: 746-757.
70. Weiner RB, Hutter AM, Wang F, Kim JH, Wood MJ, Wang TJ, Picard MH, Baggish AL. Performance of the 2010 European Society of Cardiology criteria for ECG interpretation in athletes. Heart 2011: 97: 1573-1577.
71. Wheeler MT, Heidenreich PA, Froelicher VF, Hlatky MA, Ashley EA. Cost-effectiveness of preparticipation screening for prevention of sudden cardiac death in young athletes. Ann Intern Med 2010: 152: 276-286.
72. Wilson MG, Basavarajaiah S, Whyte GP, Cox S, Loosemore M, Sharma S. Efficacy of personal symptom and family history questionnaires when screening for inherited cardiac pathologies: the role of electrocardiography. Br J Sports Med 2008: 42: 207-211.
73. Wilson MG, Carre F, Salah O, Sharma S, Prasad SK, Whyte GP, Hamilton B, Chalabi H. Significance of deep T-wave inversions in an asymptomatic athlete with a family history of sudden death: addendum - full sporting disqualification. Clin J Sport Med 2012a: 22: 284-287.
74. Wilson MG, Chatard JC, Carre F, Hamilton B, Whyte GP, Sharma S, Chalabi H. Prevalence of electrocardiographic abnormalities in West-Asian and African male athletes. Br J Sports Med 2012b: 46: 341-347.
75. Zaidi A, Ghani S, Sheikh N, Gati S, Bastiaenen R, Madden B, Papadakis M, Raju H, Reed M, Sharma R, Behr ER, Sharma S. Clinical significance of electrocardiographic right ventricular hypertrophy in athletes: comparison with arrhythmogenic right ventricular cardiomyopathy and pulmonary hypertension. Eur Heart J 2013: 34: 3649-3656.
76. Zeller L, Nechushtan A, Kobal SL, Constantini N. [Sudden cardiac death in young athletes - causes, prevention and treatment]. Harefuah 2010: 149: 515-518, 550.