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Can an EKG prevent sudden cardiac death in an athlete? A systematic review

15 August 2009


Background: Current U.S. recommendations for pre-participation screening do not include EKG. European protocol recommends EKG as part of screening and Italy has followed this standard since 1982. Five cardiac abnormalities, hypertrophic cardiomyopathy, coronary artery anomaly of wrong sinus origin, myocarditis, arrhythmogenic right ventricular cardiomyopathy, and ion channelopathies, are the most prevalent causes of sudden cardiac death in the U.S. Most of these cardiac abnormalities display intermittent EKG abnormalities. An athlete may have an abnormal EKG without any family history, symptoms, or physical exam findings of a cardiac abnormality. Could implementation of screening EKG with pre-participation physical exams for athletes uncover these abnormalities, therefore decreasing the number of sudden cardiac deaths during physical activity per year?

Hypothesis: An EKG can contribute to the pre-participation physical for athletes by detecting certain cardiac abnormalities that lead to sudden cardiac death.

Study Design: Systematic review of medical trials.

Methods: Exhaustive search of databases including Ovid Medline, Pubmed, Cinahl, and Evidence-Based Medicine Review Multifile.

Results: Five studies were found that evaluated the correlation between abnormal EKGs in athletes and the diagnosis of a cardiac abnormality that will cause sudden cardiac death. Only one study evaluated all participants with an echocardiogram as well as an EKG. A likelihood ratio of 3.04, sensitivity of 73%, and specificity of 76% was calculated using the information from this study.

Conclusion: Studies evaluated did not make a large impact on the diagnosis of hypertrophic cardiomyopathy or other cardiac abnormalities by EKG. However, cardiac abnormalities that cause sudden cardiac death were found with EKG alone, when history and physical exam findings were normal. EKGs should be incorporated into pre-participation screenings to prevent sudden cardiac death.


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