1) A study found that young competitive athletes ages 12-35 had a 2.8 times higher relative risk of sudden cardiovascular death compared to non-athletes, while the relative risk of non-cardiovascular sudden death was only 1.7 and not statistically significant. 2) Screening ECGs in competitive athletes can help identify rare heart conditions that increase risk of sudden cardiac death, but the low incidence of 1 in 50,000 and questions around cost-effectiveness, appropriate protocols, and follow-up for abnormal results require further consideration. 3) While some ECG abnormalities in athletes are common and related to training, others can indicate underlying heart disease and cardiomyopathy. Screening ECG

1. SPORT en plotse dood
Screening elektrocardiogram
voor jonge (≤35j) competitiesporters
P. GOETHALS BHC symposium 2012

2. From: Does sports activity enhance the risk of sudden death in adolescents and young adults?
J Am Coll Cardiol. 2003;42(11):1959-1963. doi:10.1016/j.jacc.2003.03.002
Figure Legend:
Incidence and relative risk (RR) of sudden death (SD) among athletes (solid columns) and non-athletes (open columns) from
cardiovascular and non-cardiovascular causes. Athletes had a 2.8 RR of cardiovascular SD (confidence interval [CI] 1.9 to 3.7; p <
0.001), as compared with a 1.7 RR of non-cardiovascular SD (CI 0.3 to 5.7; p = 0.39).
Date of download: Copyright © The American College of Cardiology.
12/3/2012 All rights reserved.

3. Distribution of cardiovascular causes of
sudden death in 1435 young competitive athletes.
From the Minneapolis Heart Institute Foundation
Registry, 1980 to 2005
Maron BJ. Circ 2007;115:1643-1655

4. ?
Cardiomyopathie
Cardiale remodelling: ras,
man/vrouw, type sport

5. Grijze zone: atletenhart of cardiomyopathie?
Maron B. N Engl J Med 2003;349:1064-1075

6. Pre-participation screening?
• Doelgroep? Alle sporters (nationaal screeningsprogramma) of
alleen competitiesporters?
• Wanneer?
• Frequentie?
• Protocol ?(anamnese, KO, ECG)
• Wie heeft expertise?
• Wie betaalt?
• Vals negatief ECG resultaat? Marfan syndroom- abnormale
oorsprong kroonslagader- myocarditis…
• Een afwijkend ECG, wat nu?
• ‘Cost effective’? Lage incidentie 1/50.000 maar veel gewonnen
levensjaren! Ann Intern Med 2010; 152: 276-286

7. Annual Incidence Rates of Sudden Cardiovascular
Death in Screened Competitive Athletes and
Unscreened Nonathletes Aged 12 to 35 Years in the
Veneto Region of Italy
(1979-2004)
4,5
Sudden death per 100000 person-years
4 Athletes
3,5 Nonathletes
3
2,5
P for trend <0.001
2
1,5
1
0,5
0
1979- 1981- 1983- 1985- 1987- 1989- 1991- 1993- 1995- 1997- 1999- 2001- 2003-
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004
Years
Corrado et al JAMA 2006;296:1593-1601

8. GROEP 1 (frequente-trainingsgebonden ECG
veranderingen)
Eur Heart J 2010; 31: 243-259
Isolated QRS voltage
criteria LVH
Sinus bradycardie
AV blok gr I
ORBTB
Vroege repolarisatie
1005 elite atleten:
402 (40%)
abnormaal ECG
240 atleten (24%)
lone QRS LVH
Pelliccia et al Circulation
2000;102: 278-284

9. GROEP 1
(frequente-
trainingsgebonden
ECG veranderingen)
Eur Heart J 2010;
31: 243-259
Isolated QRS voltage
criteria LVH
Sinus bradycardie
AV blok gr I
ORBTB
Vroege
repolarisatie

10. Opsporen van cardiomyopathie
door ECG
GROEP 2 (zeldzame-niet
trainingsgebonden ECG
veranderingen)
Eur Heart J 2010; 31:
243-259 HCM sens. 95%
Inversie T golf
ST segment depressie
Pathologische Q
LA hypertrofie Prof Sharma
QRS as afwijking/LAH/ St George’s
LPH
RVH University of London
Pre excitatie 20/10/2012
VLBTB/VRBTB
Lang of kort QT interval
Brugada like vroege
repolarisatie ARVC sens.80%

11. Screening aanbevolen ESC, IOC,
vele Europese sportfederaties

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attention
BHC bedankt U voor uw
aandacht