Appropriate interpretation of the athlete's electrocardiogram saves lives as well as money.

Long-term Italian experience has provided evidence that systematic pre-participation screening, with 12-lead electrocardiogram (ECG) history and physical examination, is effective in identifying athletes with potentially lethal cardiovascular disease and actually saves lives.1,2 However, concerns have been raised about the cost-effectiveness of screening because of the high level of false-positive results from the ECG.3 This concern arises because (i) ECG changes develop in trained athletes as a consequence of sustained physical exercise (‘athlete's heart’); and (ii) there is the misconception that most athletes’ ECG changes overlap significantly with ECG abnormalities seen in the cardiovascular diseases which cause sudden death in the young.3–5 The ECG has therefore been considered to be a poor screening tool for cardiovascular disorders in athletes because of its presumed low specificity. This concept, however, was based on a few studies of small and selected series of highly trained athletes from a limited number of sports disciplines.5,6 Systematic pre-participation screening in Italy offers the unique opportunity to investigate ECG changes in large cohorts of athletes, engaged in a broad variety of sports activities with different levels of training and fitness.1,2,4,7 The data available define the spectrum of athletes’ ECG patterns, which permits delineation of common, physiological ECG changes and uncommon ECG abnormalities which are usually unrelated to training but associated with an increased cardiovascular risk. This new perspective in the interpretation of an athlete's ECG raises the need for a revision of accuracy, utility, and cost–benefit analysis of the use of ECG in screening athletes for cardiovascular diseases. In Table 1, athletes' ECG abnormalities are divided into two groups according to their prevalence, relationship to exercise training, association with an increased cardiovascular risk, and need for further clinical investigation to … *Corresponding author. Tel: +39 049 8212458; fax: +39 049 8212309. E-mail address : domenico.corrado{at}unipd.it