The Atlantic Rift: Guidelines for Athletic Screening-Where Should Canada Stand?

Sudden cardiac death (SCD) in a young seemingly healthy athlete is a tragic and often highly publicized event. Preparticipation screening aims to identify those affected by cardiovascular diseases who may be at higher risk of SCD during sports participation. There are conflicting recommendations from the American Heart Association and the European Society of Cardiology regarding screening electrocardiograms (ECGs) before participation in sports. The use of an ECG as a screening strategy has been questioned, with a large number of abnormal test results observed in athletes resulting from the electrocardiographic changes that occur in a highly trained individual overlapping with findings suggestive of a pathologic condition. An abnormal 12-lead ECG triggers further examinations, which are expensive given the low diagnostic yield of most abnormal electrocardiographic patterns. Universal screening of young athletes poses logistic and financial challenges. There are currently no Canadian guidelines regarding preparticipation screening of athletes. Screening of athletes ignores the much larger group of young nonathletes who participate in vigorous recreational activity and who collectively represent a population in which a much larger number of SCDs can be predicted to occur. While waiting for the best screening approach in Canada, increased awareness of and access to automated external defibrillators, along with training in cardiopulmonary resuscitation, can help reduce the number of SCDs. In some jurisdictions, electrocardiographic screening has been eschewed in favour of such an approach. Specific physician training in the field of sports cardiology with availability of experts throughout Canada may be a useful start. We provide suggestions and call for the development of Canadian guidelines by appropriate organizations.