Screening electrocardiogram in young athletes and military members: a systematic review and meta-analysis

Lear, A.; Patel, N.; Mullen, C.; Simonson, M.; Leone, V.; Koshiaris, C.; Nunan, D.

Objective: To determine the effect of electrocardiogram (ECG) screening on prevention of sudden cardiac arrest and death (SCA/D) in young athletes and military members. Design: Systematic review and meta-analysis Data Sources: MEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORT discus, PEDro, were searched from inception to date searched between 2/21/19 and 3/1/19, and Clinicaltrials.gov on 7/29/19. All databases were searched without limits on language. Eligibility criteria for selected studies: Randomized and non-randomized controlled trials, where pre-participation examination including ECG was the primary intervention used to screen athletes or military 40 years of age or younger. Accepted controls were no screening, usual care, or pre-participation examination without ECG Results: 4 studies (11,689,172 participants) were included, all at high risk of bias. Pooled data from two studies (n= 3,869,274; very low quality) showed a 42% relative decrease in sudden cardiac death, equating to an absolute risk reduction of .0016%. Uncertainty was high, with a potential 67% relative decrease to a 45% relative increase in those screened with ECG based on 95% confidence intervals (RR 0.58; 95%CI 0.23, 1.45). Heterogeneity was found to be high as measured with I2 statistic (71%). Conclusion: There is very low quality evidence ECG screening decreases risk of sudden cardiac death in young athletes and military members. Decisions need to consider evidence that ECG screening could also increase risk of sudden cardiac death based on the findings of meta- analysis.