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American College of Cardiology

Clinical Articles, Lead Article

Sudden Death In Athletes Unchecked By ECG Screening

Mandatory electrocardiographic (ECG) screening of athletes prior to competition is ineffective as a precaution against sudden death, according to a study1 published recently in the Journal of the American College of Cardiology.

The authors, led by Dr Arie Steinvil, Tel-Aviv University, conducted a systematic search of the two main newspapers in Israel to determine the yearly number of cardiac arrest events among competitive athletes, in order to assess the impact of ECG screening as mandated by Israel’s 1997 National Sport Law. The size of the population at risk was retrieved from the Israel Sport Authority, and extrapolated to the changes in population size over time.


The results showed 24 documented events of sudden death or cardiac arrest events among competitive athletes during the years 1985 through 2009 – eleven occurring before the 1997 legislation, and 13 after it. The respective averaged yearly incidence during the decade before and the decade after the 1997 legislation was 2.54 and 2.66 events per 100,000 person years, respectively (p=0.88).

The authors assert that any drop in sudden death rates observed after introduction of ECG screening most likely results from the unusually high rates which typically inspire such legislation in the first place. “Only when one extends the comparison of sudden death rates to include the decade that preceded the enforcement of screening…does one realize that this mortality reduction is the result of a large variation in mortality rates over longer periods of observation,” they note.

In an accompanying editorial2 Dr Alfred Bove, Temple University School of Medicine, emphasises the danger of variant but healthy ECG results leading to unfair disqualification. Such screening, he claims, can lead to a “high number of false positive diagnoses of cardiomyopathy. The atypical echocardiography findings in an athlete are affected by the size of the athlete and by the degree and type of training”.

Dr Bove continues: “The concern is that many athletes would be disqualified based on false positive ECG findings, and we do not at present have an inexpensive method for more accurate screening”. Steinvil et al conclude that the costs of mandatory screening are so high, both for the finances of participating nations and the personal prospects of disqualified athletes, that “it is reasonable to request additional proof that such a strategy actually saves lives”.


  1. Steinvil A, Chundadze T, Zeltser D et al. Mandatory Electrocardiographic Screening of Athletes to Reduce Their Risk for Sudden Death: Proven Fact or Wishful Thinking? J Am Coll Cardiol 2011:57;1291–6.
  2. Bove AA. Making or Breaking Athletic Careers. J Am Coll Cardiol 2011:57;1297–8.

Published on: April 6, 2011

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