Genetic and congenital cardiac diseases are the leading cause of sudden death. Every week in the UK there are 12 cardiac sudden deaths in young people. There is considerable debate on who should be screened with most health care systems recommending a broad pre-participation screening, inclusive of 12-lead ECG, only in children and young adults who engage in competitive athletics programs or are at an elite-professional level. One of the concerns of such approach is that children and young adults who are not engaged in competitive screening would be excluded from such a screening, leaving them at risk of dying suddenly of the same cardiovascular conditions as athletes. Indeed, health care systems that have a adopted a more comprehensive screening approach have been able to significantly reduce the risk of sudden death in childhood and early adult life.
Researchers from Minneapolis have analysed the data retrieved from the Hannepin County registry (Minnesota) and found that the number of sudden cardiovascular deaths was 8 times higher in non-athletes than in athletes and the incidence (number of new cases) was 3 times higher. The most common causes of death were hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC).
These results underscore the ethical dilemma of limiting systematic screening only to competitive athletes as it happens in the UK as those conditions leading to sudden death could be readily detected by an experienced paediatric cardiologist with non invasive testing.