Table 4.

ECG Screening in NCAA Athletes: Key Preliminary Findings From a 2-Year Multicenter Feasibility Trial

Abnormal ECGs were present in 192 (3.7%) of athletes.

A total of 1,716 athletes (33%) reported at least 1 positive response from the AHA symptom and family history questions, demonstrating the importance of clinician input in evaluating the questionnaire response.

Thirteen conditions (0.23% of all athletes) associated with SCD or severe cardiac morbidity were identified, including:

• Wolff-Parkinson-White syndrome (n = 15)

• Large atrial septal defect with right ventricle dilation requiring surgery (n = 5)

• Hypertrophic cardiomyopathy (n = 5)

All 13 had abnormal ECGs, and 3 had an abnormal history or physical examination.

The respective false-positive rates for detecting a potentially dangerous cardiac condition by ECG, physical examination, and reported history responses were 3.4%, 2%, and 33%.

Of the abnormal ECGs, 1 in 16 (positive predictive value 6.3%) represented a potentially serious cardiac condition, whereas 1 in 1,000 (positive predictive value 0.1%) positive history responses led to detection of a serious cardiac condition.

The average time loss from sport for athletes with an abnormal ECG was 2.6 days.

The average cost of follow-up testing for the 192 student-athletes with abnormal ECGs was not assessed.

No student-athlete had an adverse medical complication from additional cardiac testing or was unnecessarily disqualified from sport.

From an NCAA-funded research study addressing the feasibility of ECG screening (Drezner [49]). The NCAA funded a 2-year, multicenter, prospective study on ECG screening in college student-athletes. Thirty-five NCAA institutions participated, and >5,200 student-athletes underwent cardiovascular screening with ECG and the AHA-recommended history and physical examination. Electrocardiograms were interpreted at a single institution by cardiologists with experience in ECG interpretation in athletes. The “Seattle Criteria” for ECG interpretation were utilized by the cardiologists to determine abnormal findings (4S). The host institution's medical team determined evaluation of ECG abnormalities, management of detected cardiac conditions, and all eligibility decisions.

NCAA = National Collegiate Athletic Association; SCD = sudden cardiac death; other abbreviations as in Table 2.