An electrocardiogram should not be included in routine preparticipation screening of young athletes.

The sudden death of a young athlete during competition is a tragic yet rare occurrence that results in significant public and media attention. Increased catecholamine response to maximum stress in subjects with underlying structural heart disease is a well-known cause of lethal cardiac arrhythmias.1 In 1996, the American Heart Association issued a scientific statement advocating universal cardiovascular preparticipation screening for high school and college athletes in an attempt to identify those at increased risk of cardiovascular events.2 The recommendations included a 12-point complete history and physical examination (including brachial artery blood pressure measurement) before competitive sports (Table 1) and reserved noninvasive testing such as a 12-lead ECG, echocardiogram, exercise testing, and cardiovascular consultation for athletes in whom any abnormality was detected.