Don’t routinely order a screening ECG as part of a sports preparticipation examination in asymptomatic, otherwise healthy patients with no personal or family history of cardiac disease.

Rationale and Comments

Routine screening ECGs for preparticipation sports clearance are not currently recommended by the American Heart Association. Instead, it is recommended that the American Heart Association’s 14-point screening guidelines, or the American Academy of Pediatrics’ “Preparticipation Physical Evaluation,” be used in conjunction with a targeted personal history, family history, and thorough physical examination. The goal is to identify warning signs or signs that raise suspicion of cardiovascular diseases that place certain athletes at risk of sudden cardiac death. These individuals should be referred for further evaluation by a pediatric cardiologist who may order an ECG or an echocardiogram as part of the work-up. Routine ECG screening of healthy pediatric patients with no personal or family history of cardiac disease has demonstrated a high false-positive rate and has not been found to reduce mortality from sudden cardiac death. In addition, it can also lead to unnecessary secondary evaluations. ECG screening should be performed in those patients with a strong family history of conditions likely to cause sudden cardiac arrest or death.

Sponsoring Organizations

American Academy of Pediatrics – Section on Cardiology and Cardiac Surgery

Sources

ACC/AHA guidelines
American Academy of Pediatrics guidelines

Disciplines

Cardiovascular
Sports Medicine

References

Maron BJ, et al.; American Heart Association, Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology; and American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 2: preparticipation screening for cardiovascular disease in competitive athletes. Circulation. 2015;132(22):e267-e272.
Maron BJ, et al.; American Heart Association, Council on Clinical Cardiology, Advocacy Coordinating Committee, Council on Cardiovascular Disease in the Young, Council on Cardiovascular Surgery and Anesthesia, Council on Epidemiology and Prevention, Council on Functional Genomics and Translational Biology, Council on Quality of Care and Outcomes Research; and American College of Cardiology. Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age). J Am Coll Cardiol. 2014; 64(14):1479-1514.
Schmehil C, Malhotra D, Patel DR. Cardiac screening to prevent sudden death in young athletes. Transl Pediatr. 2017;6(3):199-206.
American Academy of Pediatrics. Preparticipation Physical Evaluation. 5th Edition. Bernhardt DT, Roberts WO, eds. Itasca, IL: American Academy of Pediatrics; 2019.