ירחון החברה הישראלית לפדיאטריה אמבולטורית (חיפ"א) גיליון 2018-1

10 Cardiology Although we commonly screen participants in competitive sports, sudden death occurs at a higher rate among non-athletes than among athletes. In Israel, children are required to undergo a medical evaluation prior to participation in competitive sports. The US has less rigorous recommendations, excluding ECG in its routine evaluations. In this retrospective review, Maron, et al, 1 reviewed all incidents of sudden death for ages 14-23, in Hannepin County, Minnesota for the years 2000- 2014. Sudden death occurred 3 times more commonly among non-athletes (1:39,454) than competitive athletes (1:120,614). These rates of sudden death are lower than rates seen in other studies and whereas this aberration suggests that the study should be repeated elsewhere, an important question is still raised: Should we be screening all children for the risk of sudden death 2,3,4 ? We are similar to Italy in requiring an ECG for participation on competitive sports, yet lack the rigorous evaluation guidelines of interpretation that they abide by. So, the questions still remain: who should perform the evaluation and by what guidelines? This study raises an additional question: if a pre-sports evaluation, with or without ECG, should be conducted on all children. In the US, where hypertrophic cardiomyopathy is the most likely identifiable cause of SD, ECG is not routinely required, due to considerations of “cost-effectiveness” and the lower prevalence of arrhythmogenic right ventricular cardiomyopathy (in contradistinction to the Italian population). Perhaps it is time for a re-evaluation of our pre-sports screening in Israel, based on local incidence of SD, and as well as its causes. Bottom line: We need to re-evaluate pre-sports cardiovascular screening as well as risk assessment for SD in children. Special appreciation to Dr Shaul Baram and Dr Dan Hadas for their contributions. 1. Maron, Haas, Duncanson, et al. Comparison of the frequency of sudden cardiovascular deaths in young competitive athletes versus nonathletic athletes; should we screen only athletes? Am J Cardiol. 2016;117(8):1339-1341; doi: 10.1016/j.amjcard.2016.01.026 2. Link and Estes. Sudden cardiac death in the athlete; bridging the gaps between evidence, policy and practice. Circulation 2012;125:2511-2516 http://dx.doi.org/10.1161/ CIRCULATIONAHA.111.023861 3. Harmon K, et al. Frequency of Cardiac Death in NCAA Athletes: A Decade in Review. Circulation 2015; 32(1): 10-19 4. AAP Grand Rounds Nov 2016; 36:5