Sudden cardiac death (SCD) is the leading non-traumatic cause of mortality in athletes under 35, most often due to inherited cardiomyopathies or primary electrical disorders that may remain silent until a fatal event. The 12-lead electrocardiogram (ECG) is the most accessible and cost-effective screening tool, yet its early use was hampered by poor specificity and high false-positive rates, mainly due to non-standardized interpretation and limited awareness of physiological adaptations.
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This case-based review provides an overview of the most relevant supraventricular and ventricular arrhythmias in athletes, elucidating their connections with intensive exercise and sports and the risk of sudden cardiac arrest.
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Traditionally, cardiovascular screening has been recommended mostly for competitive athletes younger than 35 years. The perception that only young competitive athletes at top level are at increased risk, has changed in the last years. Theoretically, we advocate a voluntary cardiovascular screening for all athletes who exercise vigorously, independent of their competitive status, and age. Although, this should be based on an individual estimation of the athlete’s risk. Physical examination, medical history and an ECG should be the baseline investigations for all athletes.
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During our Annual meeting of the Society for Pediatric Sports Medicine in Basel 2017 one of the highlight sessions was the PRO-CON discussion about the use of a resting ECG as screening tool to detect youth at risk for sudden cardiac death. We present the two statements of the cardiology experts that were finally not so controversial as the PRO-CON may suggest.
Well as often in medicine, it is the choice of each of you, how to deal with the situation. On one side we are taught to know and listen to the “evidence in medicine”, but on the other side we so often end up in our traditional professional perspective as decision maker that is not always wrong …
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