Utilization of the International Criteria for Electrocardiogram Interpretation in Middle and High School Athletes

Background: Sudden cardiac arrest is the leading cause of death in young athletes. The addition of an electrocardiogram to the traditional history and physical exam can enhance the detection of cardiovascular disease that may predispose to sudden cardiac arrest. The international criteria for interpretation of electrocardiograms in athletes (12-35 years old) helps standardize reading and avoid false positive results. This study aims to evaluate the advantage of utilizing the international criteria versus a community pediatric cardiologist interpretation in mass electrocardiography screening in middle and high school students in the USA.

Methods: Brevard County School District in Florida in 2019 was the first district in the USA to adopt a policy mandating electrocardiogram before participation in middle or high school sports. The ECGs were provided through community screening events with a non-profit group named: Who We Play For at a low cost of $20.00 and waived for underprivileged students. The results were compiled in an Excel database. Institutional review board approved a retrospective review. The abnormal electrocardiograms were compared between the community cardiologist read versus international criteria. A Chi-Square was used for statistical analysis. A p-value <0.05 was significant.

Results: Brevard County school system had over 30,000 students enrolled in 2019. There was a total of 5,876 ECG screenings completed between the dates of 4/1/19 and 12/31/19. The pediatric community cardiologists determined 3.3% (198/5876) were abnormal compared to 0.7% (41/5876) with international criteria (P <0.001). The breakdown of abnormalities is seen in table 1.

Conclusion: The international criteria were created as a consensus on the best way to interpret electrocardiograms in athletes ages 12-35 years old. The utilization of the international criteria can reduce the abnormal rate of mass pre-sports participation ECG screening in middle and high school students from >3% to <1%.