Should athletes have to undergo mandatory
electrocardiographic screening (also known as ECG or heart trace) before
competing? Doctors debate the issue in this week's BMJ.
Antonio Pelliccia and Domenico Corrado argue that screening
athletes for "silent" heart problems would save lives. They say the best
evidence of the efficacy of ECG screening on mortality in athletes comes from
Italy, the only country where it is required by law, and where a mass screening
programme has been in place for almost 30 years.
The incidence of sudden deaths before and after
implementation of the programme fell by 89%, and no deaths were reported among
athletes disqualified from competition because of hypertrophic cardiomyopathy.
They say this supports the idea that timely identification of affected athletes
offers the possibility to improve survival.
"Cardiovascular screening for young competitive athletes is
justifiable and compelling on ethical, legal, and medical grounds" they argue.
But in an opposing piece, Dr Roald Bahr argues that the
diagnostic accuracy of ECG screening varies, that false positives can be as
high as 40%, and that some conditions, such as coronary atherosclerosis, are
likely to remain undetected.
The conditions that cause cardiac death differ substantially
between populations, he says. He argues that a screening programme that has
successfully identified cardiomyopathies in Italy will not necessarily be
effective in, for example, Norway, where this seems to be a rare cause of
He argues that because diagnostic accuracy is low, and
depends on which cardiac conditions are the main causes of sudden death, ECG
screening for athletes would fail public health criteria.
"Screening of hundreds of thousands of athletes to save
possibly one life a year, cannot be justified," he concludes.