The Validity of Adding ECG to the Preparticipation Screening of Athletes An Evidence Based Literature Review

OBJECTIVE To review the available evidence establishing the validity of adding electrocardiogram to the preparticipation cardiac screening in athletes. DATA SOURCES MEDLINE and CINAHL databases were searched. Additional references from the bibliographies of retrieved articles were also reviewed and experts in the area were contacted. SELECTION CRITERIA Only original research articles seeking to establish the use of electrocardiography followed by second line investigations in athletes under 36 years of age were reviewed. SEARCH RESULT AND QUALITY ASSESSMENT The initial literature search identified 226 papers. Of these, 16 original articles (all type II evidence-population-based clinical studies) met the selection criteria and directly related to the use of electrocardiography in athletes cardiac screening. The methodological qualities of included studies were assessed using the Downs and Black checklist. CONCLUSION Screening with electrocardiography represents best clinical practice to prevent or reduce the risk of sudden cardiac death in athletes. It significantly improves the sensitivity of history and physical examination alone; it has reasonable specificity and excellent negative predictive value; and it is cost-effective. Future studies must be large, multicentre, multination, prospective trials powered to determine how different screening options affect the incidence of sudden cardiac death. Efforts should also be targeted toward secondary prevention of sudden cardiac death with pitch side cardiac resuscitation and the immediate use of defibrillator.