**10. Routine ECG as a screening tool**

The Task Force on Preparticipation Screening for Cardiovascular Disease in Competitive Athletes of AHA/ACC [5, 48, 51, 52] does not recommend routine ECGs and echocardiograms for pre-participation screening. On the other hand, the International Olympic Committee [66] and the European Society of Cardiology [67] guidelines recommend routine screening with a 12-lead ECG along with history and physical examination. Pre-participation screening ECG does not increase the diagnostic accuracy, is not practical, is not sensitive, and is not specific. In addition, both false positives and false negatives (5–20%) exist with the ECG [68]. However, it may detect patients with hypertrophic cardiomyopathy, WPW syndrome, atrioventricular block, long QT syndrome, and Brugada syndrome.

The justification for AHA/ACC guidelines for not recommending routine recording of ECGs as a part of pre-participation screening may be summarized as follows: 1. ECG is not sensitive and is not specific with false-positive ECGs taking place way

*Pre-Sports Participation Cardiac Screening Evaluation – A Review DOI: http://dx.doi.org/10.5772/intechopen.102942*

above true-positive ECGs, 2. The incidence of cardiac conditions leading to sportsrelated deaths is rather low (5 out of 100,000 subjects), 3. The athlete group to be screened is of the considerable size (10 million in the USA and much larger worldwide), 4. Routine ECG screening will impose a large price tag of roughly 2 Billion dollars/year, and 5. There is no adequate physician pool to do and interpret this large number of ECGs. Furthermore, the subjects with undiagnosed cardiac abnormality may present with symptoms, namely chest pain, exertional dyspnea, or syncope which may be uncovered by the screening questionnaire. Since some of the entities have a genetic and familial origin, they may be discovered by the screening protocol. Finally, studies comparing the strategies with and without ECG during screening did not demonstrate a mortality benefit in the group with routine ECGs [52, 54, 69]. Based on these and other considerations, the author is in support of not performing ECG during pre-participation screening [3] and recommends careful attention to implementing the 14-point AHA/ACC pre-participation screening protocol.
