Electrocardiograms should be included in preparticipation screening of athletes.

Among the adolescent and young adult population, the absolute risk of sudden cardiac arrest (SCA) is low, whereas the benefits of identifying predisposing conditions and preventing SCA are disproportionately large.1,2 Competitive athletes included within this population subgroup are at higher risk of SCA than expected for the general population in this age category.3–5 Recently, there has been considerable debate in the United States about the appropriate strategies, effectiveness, and logistics of various preparticipation screening techniques for identifying individuals at risk. Despite the recommendations of the European Society of Cardiology (ESC)6 and the International Olympic Committee (IOC)7 that an ECG be added to the preparticipation screening process, the American Heart Association (AHA) has recently reaffirmed its long-held position on preparticipation screening for cardiovascular abnormalities in competitive athletes.8 The AHA suggests that ECG screening is not warranted as a component of preparticipation evaluations unless specific observations in the history or physical examination exist that trigger a more extensive cardiovascular evaluation.8 This position is retained despite various sources of data supporting an incremental benefit attributable to routine ECG screening.9 General agreement exists on preparticipation screening guidelines that include an appropriate personal medical and family history and physical examination, but the inclusion of additional elements such as an ECG is in dispute. The purpose of this article is to respond to the AHA recommendation and to provide a reasoned alternative approach.