Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 Years of Age): a scientific statement from the American Heart Association and the American College of Cardiology.

Sudden death (SD) of young people because of a variety of complex, predominantly genetic/congenital cardiovascular diseases is a riveting, devastating event and a public health and policy issue of increasing concern.1–6 The reliable identification of such individuals at risk for SD has become a major focus of the cardiovascular community for a number of reasons, including the opportunity to reduce SD events through selective disqualification from sports7 and the primary prevention of SD with the implantable cardioverter-defibrillator for some high-risk patients with genetic heart diseases.8–14 In addition, those SDs caused by underlying and unsuspected genetic or congenital cardiovascular diseases that occur in young trained athletes are a highly visible issue and have become a concern in both the public arena and the physician community.15–17 Consequently, the desire to screen populations theoretically at risk for cardiovascular disease to reduce morbidity and mortality is understandable in principle, and few would empirically argue against the potential benefit of this practice for some individuals. However, a debate has emerged regarding whether the conditions responsible for these tragic events can be detected effectively in populations of various sizes by the available testing and examination techniques, and specifically, there is debate concerning which strategies are potentially the most reliable to separate those individuals with disease from those who are probably unaffected.15–29 Most of this dialogue concerning SD prevention has been limited to the screening of young populations of competitive athletes, and the available data specifically related to cardiovascular screening efficacy (on which we largely and unavoidably rely) overwhelmingly come from such populations exclusively composed of trained athletes. Periodically, this has become a polarized controversy and public health debate, triggering a large and growing body of literature, including clinical studies… but notably also an …