LAUSR

A preparticipation evaluation is recommended before engaging in competitive sports, although debate continues whether to include an ECG in addition to a history and physical examination. The limitations of preparticipation screening by history and physical examination alone for the identification of athletes with disorders at risk for sudden cardiac arrest have been recognized by 2 recent consensus statements within the United States.1,2 ECG screening of young athletes is endorsed by several major medical and sporting organizations, such as the European Society of Cardiology (ESC), International Olympic Committee, and Federation Internationale de Football Association, as a means to improve the identification of conditions predisposing to sudden cardiac arrest. However, accurate implementation of an ECG screening program has many challenges and requires a physician infrastructure with adequate sports cardiology resources and training in contemporary athlete-specific ECG interpretation standards. See Article by Dhutia et al In this issue, Dhutia et al3 examined the reproducibility of ECG interpretation using the 2010 ESC, 2013 Seattle Criteria, and 2014 Refined Criteria by 4 experienced and 4 nonexperienced cardiologists in 400 athletes. The study also analyzed the downstream costs of further testing depending on the experience level of the reader. Not surprisingly, the study found that interobserver reliability was better with experienced versus novice readers and improved for both groups with the newer criteria. This was a small sample, and no follow-up was available so it is unknown if any athlete in this cohort had true disease. Physiological changes in the athlete’s heart have made determination of normal ECG findings in the athlete a challenge. The 2010 …