Editorial How Important Is the Electrocardiogram in Protecting and Guiding the Athlete?

Sudden cardiac death in the young athlete is a devastatingevent, widely commented on by the media and followed by a question: How can we prevent this from happening in the future? Article see p 746 Previous estimates of sudden cardiac death in athletes in the United States have varied widely, and therefore we welcome a recent study by Harmon et al.1 Using the National Collegiate Athletic Association database and information from the Parent Heart Watch, they found an incidence of 1:43 770 per year over a 5-year period covering a total of 1 969 663 athlete participant-years. They also provided infor-mation on the relation between incidence of sudden cardiac death and sex, ethnic background, and type of sport. Male athletes were more than twice as likely as female athletes to die suddenly (1:33 134 versus 1:76 646 per year). The risk was clearly higher among black compared with white athletes (1:17 696 versus 1:58 653 per year). There were also differ-ences in the rate of sudden cardiac death in various athlete subgroups. Athletes with the highest risk were Division I male basketball players (1:3126 per year). Harmon et al1 concluded that accurate assessment of sudden cardiac death incidence in the different subgroups is essential to shape appropriate health policy decisions and to develop effective strategies for prevention. What is the value of the ECG in helping us develop those strategies? With this question in mind, we should read the article in the current issue of Circulation addressing the ECG of the athlete.2 It was written by an international group of experts who compare their recommendations with a recent publication by a group of authors representing the Section of Sports Cardiology o