Abstract
Prevention of sudden cardiac arrest/death (SCA/D) among athletes is a universal goal,
although the optimal strategy for its achievement is controversial, with the inclusion
of the 12-lead electrocardiogram (ECG) at the center of the debate. The ECG exhibits
superior sensitivity over history and physical examination to detect conditions associated
with SCA/D. However, the identification of disease does not necessarily lead to a
significant reduction in SCA/D. The “Canadian Cardiovascular Society/Canadian Heart
Rhythm Society Joint Position Statement on the Cardiovascular Screening of Competitive
Athletes” recommended against the routine performance of an ECG for the initial cardiovascular
screening of competitive athletes. The incidence of SCA/D among athletes (<35 years
of age), the risk of SCA/D during sport participation among individuals with abnormalities
found on screening ECG, the efficacy of the ECG to identify conditions associated
with SCA/D, and the positive predictive value of an abnormal ECG to predict SCA/D
are critically examined. This review presents the evidence informing the panel’s recommendation.
Résumé
La prévention de l’arrêt cardiaque soudain (ACS) et de la mort subite d’origine cardiaque
(MSOC) chez l’athlète constitue un objectif universel, bien que la stratégie optimale
pour sa réalisation soit controversée, l’inclusion de l’électrocardiogramme (ECG)
à 12 dérivations se trouvant au centre du débat. Comparativement à l’anamnèse et à
l’examen physique, l’ECG présente une sensibilité supérieure quand il s’agit de détecter
les troubles associés à l’ACS et à la MSOC. Cependant, le dépistage d’un état pathologique
ne se traduit pas nécessairement par une réduction significative des cas d’ACS et
de MSOC. Dans l’énoncé de position conjoint de, la Société canadienne de cardiologie
et de la Société canadienne de rythmologie sur le dépistage cardiovasculaire des athlètes
de compétition, le recours systématique à un ECG pour le dépistage initial des troubles
cardiovasculaires chez les athlètes de compétition est déconseillé. L’incidence de
l’ACS et de la MSOC chez l’athlète (< 35 ans), le risque qu’ils surviennent pendant
la pratique d’activités sportives chez les sujets présentant des anomalies qu’un ECG
a permis de détecter, l’efficacité du dépistage par ECG des troubles associés à l’ACS
et à la MSOC, de même que la valeur prédictive d’un résultat d’ECG anormal au regard
de ces deux entités cliniques sont l’objet d’un examen critique. Le présent article
de synthèse expose les données probantes sur lesquelles se fonde la recommandation
du groupe.
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Article info
Publication history
Published online: August 22, 2019
Accepted:
August 1,
2019
Received:
June 24,
2019
Footnotes
See page 1565 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
