Risk of sudden cardiac death in young athletes: Which screening strategies are appropriate?

Resources are not available to evaluate all young athletes before participation in competitive sports. Therefore, the cardiovascular evaluation of young athletes needs to be targeted at high-risk areas and focus on individuals who are at greatest risk, who have symptoms, and who have family history of sudden death or premature cardiac disease. It is hoped that the support and involvement of amateur and professional sporting bodies would improve the safety of athletic participation; however, sometimes they resent disqualification of their most capable athletes or have inherent conflict of interest as do many of the families of youngsters who are at risk. There are no data related to how many expected deaths can be avoided by any combined screening detection protocol. Thus, a national study with progressively complex use of testing protocols (simplest physical examination and history up to a cardiac MRI), combined with outcome arms is needed to establish the efficiency, cost-effectiveness, sensitivity, and false positive detections of possible abnormalities that had been previously noted in the various protocols for screening that are in use.