No matter which side of the debate you are on, one thing can be certain… the reaction to mandatory ECG screening of athletes is an emotional one. Proponents say if just one life can be saved it’s worth the cost and effort. Opponents say it leads to false positives, costly and potentially needless additional testing, and emotional trauma of exclusion from participation, even if it is temporary.
Recently, Brian Hainline, Chief Medical Director for the NCAA, found out just how highly charged the subject is at the collegiate level. Armed with extensive multi-year research, he set out to make ECG screening mandatory for all Division 1 athletes under the auspices of preventing sudden deaths like happened to Hank Gathers. Hainline has since walked back the mandate instead providing guidelines on how to use ECG’s to predict tragic events. In addition, recommendations were made on emergency action planning and having automatic external defibrillators (AED) be available during practice and play.
First let me say, I’m not opposed to ECG testing…it has value in diagnosing specific heart abnormalities. I DO have an issue to screening practices that ONLY use ECG as a means for providing what is promoted as a heart screening. ECG has been the tool of preference for some organizations due to the low per-test cost and ease to perform.
Heart defects come in several forms, both electrical & structural. Electrical defects can cause the heart to beat irregularly or rapidly, and can even cause it to stop beating altogether. ECG is most effective in detecting these irregularities.
Structural defects arise from abnormal formation of the heart or major blood vessels and can be due to genetic or developed condition. There are at least 18 distinct types of heart defects with many additional anatomic variations. Echocardiograms (echo) are most effective in detecting structural defects.
The ECG has the capability of raising suspicion for or identifying certain genetic cardiovascular diseases as true-positive results, including ion channelopathies and Hypertrophic Cardiomyopathy, (HCM). But here’s why testing with only ECG’s is a bad idea:
The ECG is subject to issues related to consistency, reproducibility, and variability in interpretation.
Using ECG’s for genetic or congenital cardiovascular disorders in young people has inherent limitations, particularly in the relationship between different structural forms of heart disease that are known to cause SD in the young. In other words, ECGs can miss dangerous heart problems. For those with HCM, a thickening of the heart muscle, and the most common cause of sudden cardiac death in youth, research shows that at least one in 10 will have a normal ECG.
Coronary artery anomalies are the second-most common cause of death in youth and are missed at least nine out of 10 times through ECG alone.
If an ECG does indicate there may be an issue, additional testing is required to further diagnose, typically an echocardiogram (echo). If the echo is done in a physician’s office or hospital, expect a bill of at least $1500, which many times is applied to your insurance plan deductible.
A thorough heart screening should include the 14-point AHA questionnaire, blood pressure, ECG and echo. The screening program should also be lead by a pediatric cardiologist, (if the testing is done on kids under 18 years old), and each participant’s results evaluated and communicated with the family and their personal physician.
Most parents assume when they sign their child up for a heart screening the entire heart is being evaluated, including heart walls, coronary arteries, valves, etc. for underlying and undetected genetic, congenital, or acquired cardiovascular diseases. Parents and kids deserve the highest quality heart screening available so they can take corrective action if necessary. Any screening effort should include the 14 Point Questionnaire, Blood Pressure readings, ECG tracing, and an echo (all that can be delivered for under $129) to give the best opportunity to diagnose structural and electrical issues. After all, do we buy our kids the cheapest athletic shoes or the type that will give them the best opportunity to perform safely and at the highest level?
AUTHOR: Eric Schroeder has spent the last 25 years in healthcare with an emphasis on cardiovascular testing, committing to use his knowledge to educate, create awareness, and screen for heart issues facing today’s youth. Eric is the Chief Operating Officer for Athletic Testing Solutions and has become a leader in providing high-quality screening of undiagnosed heart conditions in student athletes and young people.