As today’s Heart Beat column reports , a group of international experts recently published recommendations for interpreting the electrocardiograms of young athletes, hoping to reduce the number of false positive results that can spark further, costly testing. The debate over whether high-school and college athletes should routinely have ECGs added to their pre-participation physicals has been brewing for years , sparked by the rare but shocking deaths of young, seemingly healthy athletes on the field of play. Routine ECG screening for young athletes is currently not recommended by the American Heart Association nor mandated by the National Collegiate Athletic Association, though some colleges do screen all or some of their athletes. The University of Washington, in Seattle, for example, now mandates screening for all student-athletes. C.J. Wilcox will be a red-shirt sophomore on the school’s basketball team this year. He was screened two years ago and says he wasn’t particularly worried about his heart risk, since he had no family history or personal symptoms that would suggest a problem. He says the test was quick and easy — and showed his heart was functioning normally. “It was good to know that everything is working properly,” he says. Meantime, hospitals are increasingly offering screening programs for local high-school athletes. While the notion is appealing, and the ECG itself isn’t that expensive, the cost of resulting follow-up exams can add up. A study by Stanford cardiologists has shown that screening can be cost-effective , assuming the scans would be interpreted correctly. But it’s not at all clear whether there’s a properly trained workforce in place to screen all

high-school and college athletes, says Stephen Rice, director of pediatric sports medicine at Jersey Shore University Medical Center. “The number of people who are really qualified to read and interpret these with a degree of certainty is limited,” he says. Rice, who chaired a task force examining ways to address sudden death in New Jersey’s young athletes, says the pre-participation physical itself, without ECG, could be made better by ensuring doctors do them properly and that parents and students take them seriously. “We need to make sure that parents know when they fill out a history form, there’s a reason we’re asking them questions,” he says. “Getting accurate information is pivotal” to separating out the small number of students who might benefit from ECG, he says. Paul Matherne, a professor of pediatrics at the University of Virginia and past chairman of the American Heart Association’s Council on Cardiovascular Disease in the Young, also agreed the history and physical could be improved — by making sure a parent is present. “Teenagers might not be honest when asked about dizziness or heart palpitations” if they feel their sports participation is at risk, he says. In addition, more people need to be trained to administer CPR and to call 911 when someone — be it an athlete or spectator — has collapsed and has no pulse, he said. And automated external defibrillators should be located near the field of play, with people trained to use them, other experts said. Image: CarbonNYC via Flickr

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The Ongoing Controversy Over Screening Young Athletes With ECG