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Preparticipation screening in order to prevent sudden cardiac death: 'Italian design' for Dutch athletes?

Preparticipatiescreening om plotse hartdood te voorkomen: 'Italian design' voor Nederlandse sporters?

Synopsis

Performing a properly designed study into the cost-effectiveness of a compulsory medical examination for competitive athletes to detect hidden cardiac disease is infeasible. Due to the rarity of the underlying disorders an unrealistically large number of individuals would need to be included. This would be difficult to realise and would be very expensive. Sudden cardiac death in young people (aged 35 years or under) during physical activity is usually caused by congenital or hereditary heart disease. For that reason, experts in the Netherlands have recommended to follow the example of Italy and introduce a mandatory preparticipation cardiac screening for all competitive athletes. Such a screening comprises an electrocardiogram (ECG), a short questionnaire and a physical examination. Such is the outcome of an extensive study of the literature carried out by the RIVM at the request of the Society for Sportsmedicine. Sudden cardiac death in young people is quite rare. In the Netherlands it probably occurs with a frequency of at most one hundred cases each year, compared to a large number of athletes. However, the emotional impact is great. A voluntary screening of athletes including an ECG can certainly contribute to the detection of hereditary or congenital diseases of the heart that may cause sudden cardiac death at a young age. However, an ECG will not identify all relevant heart disorders, as appears from the study. Moreover, many false positives will be found, causing unnecessary distress. In order to gain more insight into the causes of sudden cardiac death, it is recommended to continue and further elaborate the initiatives that have already been started. An example is a registry of sudden death in athletes. In addition it is advisable to further investigate ECG abnormalities among those engaged in intensive physical activity.
 

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