LAUSR

Young athletes deserve special care in all aspects of sports and, in particular, in the prevention of the potential deleterious consequences. Cardiovascular sudden death, although extremely rare, should be carefully addressed in pre-participation screening programmes, keeping in mind the special features of young athletes. Athletes training for competitive sports are encouraged, under current guidelines, to undergo a review of clinical history and a physical examination, but the role of the electrocardiogram (ECG) in the pre-participation cardiovascular screening protocol is still a topic of passionate debate. The central arguments concern accuracy, cost-effectiveness and the need for more robust evidence supporting improved outcomes based on ECG screening. Randomised clinical trials would certainly clarify whether ECG screening improves clinical outcomes, but ethical, legal and logistic issues present important challenges. Alternatively, well-designed observational studies with a long follow-up could partially address this issue. In recent years, researchers have improved the accuracy of ECG interpretation and, arguably, the cost-effectiveness of ECG screening. Early electrocardiographic criteria of the European Society of Cardiology had low specificity, which led to an unacceptably high number of false positives and rather low efficiency when added to pre-participation screening programmes. In the quest to optimise cost-effectiveness, efforts to standardise ECG interpretation have produced notable success. T-wave inversion (TWI) in precordial leads (V1–V4) has drawn the most attention because of common misdiagnoses and variable interpretation even among sports medicine physicians and cardiologists.