Challenges of in-competition cardiac screening: lessons from the 12th FINA World Swimming Championships (25 m) Swimmer's Heart project

Ensuring the health of the elite athlete is embedded in the Olympic Movement Medical Code,1 and a top priority for International Sports Federations (IF).2 With this objective in mind, cardiovascular preparticipation screening (PPS) is now widely advocated.3–5 While seen as a necessary step in the prevention of the often silent conditions associated with sudden cardiac death (SCD), reports documenting its implementation among the various IFs are sparse. Fifty-six per cent of IFs currently implement PPS,2 however, only FIFA has documented their findings regarding the feasibility of such practice. The adaptive response to intensive continuous exercise varies greatly depending on the sport played, and so the determination of normative cardiac values per sport has benefits when interpreting the standardised, sport-unspecific guidelines currently in place. The selection bias among some sports may also lead to a greater incidence of pathology associated with SCD.6 One of the challenges often faced by IF's in implementing a successful screening programme is the global representation of athletes. Historically, it was therefore …