Evaluation of an Electrocardiogram Interpretation Tool for Use in the Cardiac Screening of Young Competitive Athletes

Abstract

Background A very small proportion of young competitive athletes are at risk of sudden cardiac death during periods of exercise. This is due to undiagnosed cardiac pathology. Screening with electrocardiogram may help detect cardiac pathology in these young athletes. Aims The first aim of this research portfolio is to review the literature in the domain of screening for sudden cardiac death in young competitive athletes. The second is to conduct a randomised trial to assess whether an electrocardiogram criteria tool can improve the interpretation of young athletes electrocardiograms. The final two aims are to publish the findings of the trial in a peer-reviewed journal, and subsequently present those findings at an international conference of the author’s peers. Methods A literature review was conducted by performing a Medline search using the following keywords: ‘death, sudden cardiac,’ ‘mass screening,’ ‘athletes’ and ‘electrocardiography.’ This allowed for a broad examination of the literature in a number of areas. These included sudden cardiac death epidemiology and pathology, screening rationale, the role of the electrocardiogram and the efficacy of current screening programmes and athlete-specific electrocardiogram criteria. The study was a randomised controlled trial of an electrocardiogram interpretation tool for the cardiac screening of young athletes. The study used a population of clinicians likely to be involved in the screening of young athletes. Clinicians were randomised to use the tool or not. Outcome measures were accuracy, sensitivity, specificity and false-positive rates of electrocardiogram interpretation. The research publication and presentation were derived from the study trial. Results Sudden cardiac death is an occurrence with an incidence that varies between populations and is caused by a variety of diseases. In rare cases, young competitive athletes may unknowingly suffer from one of these diseases and may therefore be at risk of sudden death. These diseases may be detected by screening young athletes with electrocardiograms. The utility of the electrocardiogram can be improved by applying athlete-specific interpretation criteria. A randomised controlled trial demonstrated that clinicians of varying grades were able to demonstrate superior electrocardiogram interpretation when using an electrocardiogram interpretation tool to screen young athletes. The trial results have been successfully published and presented. Conclusion Use of an electrocardiogram interpretation tool leads to superior performance by clinicians when performing cardiac screening on young competitive athletes. This has implications for prevention of sudden cardiac death in young athletes.