ECG screenings do not reduce sudden death in competitive athletes
In most young competitive athletes (less than 35 years of age) sudden death is due to congenital cardiovascular disease. Hypertrophic cardiomyopathy appears to be the most common cause of such deaths, accounting for about half of the sudden deaths in young athletes.
According to the Mayo Clinic there are 250,000 to 450,000 sudden cardiac arrests each year in the United States alone, but most deaths due to sudden cardiac arrest are in older adults. Of those sudden cardiac arrests, very few occur in young people, and only some of those young people die of sudden cardiac arrest.
Dr. Barry J. Maron, MD, MHIF researcher and director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation in Minneapolis, commented in a release "Screening initiatives for high school-aged athletes has the potential to impact 10-15 million young adults in the U.S..” "This is a controversial issue because some are suggesting that all young competitive athletes should be screened with a 12-lead ECG screening, which would be a massive and costly undertaking. Also, we do not have any evidence to show whether this is clinically necessary."
In order to determine if there is a need for the ECG screening, Dr. Maron and associated examined forensic case records from the U.S. National Registry of Sudden Death in Athletes over a 26-year period (1986-2011) in order to determine events that were judged to be cardiovascular in origin which occurred in organized competitive interscholastic sports participants in Minnesota. There were 13 incidence of sudden deaths in high school student-athletes related to physical exertion during competition (7) or at practice (6). The ages were 12 to18 and each was a white male. Most common sports involved were basketball, wrestling or cross-country running.
The researchers found that sudden death had occurred in one out of 150,000 participants. Autopsy examination documented cardiac causes in 7 of the 13 deaths. However, cardiovascular diseases could only be reliably detected by history, physical examination or 12-lead ECG in only four of the athletes which equals to one in one million participants.
Dr. Maron commented "This very low event rate does not warrant changing the current national screening strategy, especially because only one-third of the deaths would have been detectable through additional screening.”
In closing he says "These findings demonstrate that these tragic events are rare. In addition to these data, no evidence in the medical literature has shown that ECGs reduce mortality in a broad-based screening effort.”
This new research was presented March 10th at the American College of Cardiology (ACC) Scientific Sessions.
Researchers from Stanford University School of Medicine and Lucile Packard Children's Hospital in a 2011 study had found pediatric cardiologists re prone to misinterpreting electrocardiograms when using the results to determine whether young athletes have heart defects that could make exercising dangerous.
Allison Hill, MD, pediatric cardiologist at Children's Hospital Boston and study’s first author commented "An ECG doesn't always pick up the abnormalities that may predispose someone to sudden cardiac death.” "And this exam can be difficult to interpret, even if the person reading the scan is a pediatric cardiologist."
The study was published in the July 14th online in the Journal of Pediatrics.
More information on sudden cardiac death can be found online at the Cleveland Clinic.