Skip to main content

Das 12-Kanal-Ruhe-EKG in der sportmedizinischen Untersuchung von Kindern und Jugendlichen

Stellungnahme der Arbeitsgemeinschaft Herzkreislauferkrankungen der Gesellschaft für Pädiatrische Sportmedizin

The 12-lead resting ECG in sport medical examinations of children and adolescents

Statement of the working group on cardiovascular diseases of the Society of Pediatric Sports Medicine

A Leserforum to this article was published on 25 June 2020

A Leserforum to this article was published on 25 June 2020

Zusammenfassung

Die Gesellschaft für pädiatrische Sportmedizin (GPS) will einen aktiven Lebensstil von Kindern und Jugendlichen fördern und unterstützt den grenzüberschreitenden Austausch von Experten mit dem Ziel, die körperliche Aktivität von Kindern, Jugendlichen und jungen Sportlern durch gemeinsame Positionen zu fördern.

Bis heute ist die Vorbeugung des plötzlichen Herztods („sudden cardiac death“, SCD) im Sport eine medizinische Herausforderung. Durch die Ableitung eines Ruhe-EKG können verschiedene SCD-bedingte elektrische oder strukturelle Herzerkrankungen vermutet oder diagnostiziert werden. Die Bedeutung des 12-Kanal-Ruhe-EKG zur Erkennung dieser Risikokonstellationen wird jedoch intensiv diskutiert.

Das GPS empfiehlt die Ableitung eines 12-Kanal-Ruhe-EKG als Standard für die sportmedizinische Untersuchung von wettkämpfenden Kindern und Jugendlichen ab einem Alter von 12 bis 14 Jahren, mindestens alle 2 Jahre. Eine sportartspezifische frühere Teilnahme an Wettbewerben ist individuell zu prüfen.

Aktuelle Empfehlungen zur Beurteilung des Ruhe-EKG bei Sportlern, die trainingsbedingte Herzanpassungen in Betracht ziehen, führen zu einer bestmöglichen Sensitivität und Spezifität. Um jedoch nachteilige Folgen von falsch-negativen oder falsch-positiven Befunden zu vermeiden, muss die Beurteilung von Ärzten und Kinderärzten durchgeführt werden, die über Fachkenntnisse in pädiatrischer Sportmedizin und der aktueller Kriterien verfügen.

Abstract

The Society for Pediatric Sports Medicine (GPS) aims to promote an active lifestyle for children and adolescents and supports transnational exchange of experts with the aim of promoting physical activity in children, adolescents and young athletes through common positions.

To date, the prevention of sudden cardiac death (SCD) in sports still poses a medical challenge. By establishment of a resting electrocardiogram (ECG), various SCD-related electrical or structural heart conditions can be suspected or diagnosed. Nevertheless, the importance of the 12-lead resting ECG used to detect these risk constellations is under intensive discussion.

The GPS recommends the derivation of a preparticipation 12-lead resting ECG as a standard in sports medical examinations of children and adolescents who compete in sports, at least every 2 years beginning from the age of 12–14 years. A sport-specific earlier participation in competitions must be individually controlled.

Current recommendations for the assessment of the resting ECG in athletes, which take the training-related cardiac adaptations into consideration, lead to the best possible sensitivity and specificity; however, to avoid disadvantageous consequences from false negative or false positive findings, the assessment must be done by physicians and pediatricians with expertise in pediatric sports medicine and the currently used criteria.

This is a preview of subscription content, access via your institution.

Abb. 1

Literatur

  1. Maron BJ (2003) Sudden death in young athletes. N Engl J Med 349:1064–1075

    CAS  Article  PubMed  Google Scholar 

  2. Maron BJ et al (2009) Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006. Circulation 119(8):1085–1092

    Article  PubMed  Google Scholar 

  3. Van Camp SP, Bloor CM, Mueller FO et al (1995) Non-traumatic sports death in high school and college athletes. Med Sci Sports Exerc 27:641–647

    PubMed  Google Scholar 

  4. Corrado D et al (2003) Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol 42:1959–1963

    Article  PubMed  Google Scholar 

  5. Corrado D et al (2008) Pre-participation screening of young competitive athletes for prevention of sudden cardiac death. J Am Coll Cardiol 52(24):1981–1989

    Article  PubMed  Google Scholar 

  6. Maron B, Shirani J, Poliac L et al (1996) Sudden death in young competitive athletes: clinical, demographic and pathologic profiles. JAMA 276:199–204

    CAS  Article  PubMed  Google Scholar 

  7. Corrado D, Thiene G, Nava A, Rossi L, Pennelli N (1990) Sudden death in young competitive athletes: clinical correlations in 22 cases. Am J Med 89:588–596

    CAS  Article  PubMed  Google Scholar 

  8. Bohm P, Scharhag J, Meyer T (2016) Data from a nationwide registry on sports-related sudden cardiac deaths in Germany. Eur J Prev Cardiolog 23(6):649–656

    Article  Google Scholar 

  9. Löllgen H, Leyk D, Hansel J (2010) Sportärztliche Vorsorgeuntersuchung im Breiten- und Freizeitsport. Dtsch Arztebl 107:742–749

    Google Scholar 

  10. Thompson PD (2009) Preparticipation screening of competitive athletes. Circulation 119:1072–1074

    Article  PubMed  Google Scholar 

  11. Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D, Dimeff R, Douglas PS, Glover DW, Hutter AM Jr, Krauss MD, Maron MS, Mitten MJ, Robert MO, Puffer JC (2007) Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association council on nutrition, physical activity, and metabolism: endorsed by the American College of Cardiology Foundation. Circulation 115:1643–1655

    Article  PubMed  Google Scholar 

  12. Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, Okin PM, Saul JP, Salberg L, Van Hare GF, Soliman EZ, Chen J, Matherne GP, Bolling SF, Mitten MJ, Caplan A, Balady GJ, Thompson PD (2014) Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12–25 years of Age). A scientific statement from the American Heart Association and the American College of Cardiology. Circulation 130:1303–1334

    Article  PubMed  Google Scholar 

  13. Löllgen H, Börjesson M, Cumminskey J, Bachl N, Debruyne A (2015) The pre-participation examination in sports: EFSMA statement on ECG for pre-participation examination. Dtsch Z Sportmed 66:151–155

    Article  Google Scholar 

  14. Fritsch P, Fritz M, Förster H, Gitter R, Kitzmüller E, Köstenberger M, Nehrer S, Schober P (2015) Sport- und Wettkampftauglichkeitsuntersuchungen im Kindes- und Jugendalter. Monatsschr Kinderheilkd 163:1030–1036. https://doi.org/10.1007/s00112-015-3355-2

    Article  Google Scholar 

  15. Chatard JC, Mujika I, Goiriena JJ, Carré F (2016) Screening young athletes for prevention of sudden cardiac deaths: practical recommendations for sports physicians. Scand J Med Sci Sports 26:362–374. https://doi.org/10.1111/sms.12502

    Article  PubMed  Google Scholar 

  16. Marti B, Villiger B, Hintermann M, Lerch R (1998) Plötzlicher Herztod beim Sport: Sinnvolle Vorsorgeuntersuchungen und Präventionsmassnahmen. Schweiz Z Sportmed Sporttraumatol 46:83–85

    Google Scholar 

  17. Chaitman BR (2007) An electrocardiogram should not be included in routine preparticipation screening of young athletes. Circulation 116:2610–2615

    Article  PubMed  Google Scholar 

  18. Mont L, Pelliccia A, Sharma S, Biffi A, Borjesson M, Terradellas JB, Carré F, Guasch E, Heidbuchel H, La Gerche A, Lampert R, McKenna W, Papadakis M, Priori SG, Scanavacca M, Thompson P, Sticherling C, Viskin S, Wilson M, Corrado D (2017) Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Eur J Prev Cardiolog 24(1):41–69. https://doi.org/10.1177/2047487316676042

    Article  Google Scholar 

  19. Fritsch P, Pozza RD, Ehringer-Schetitska D, Jokinen E, Herceg V, Hidvegi E, Oberhoffer R, Petropoulos A (2018) Cardiovascular pre-participation screening in young athletes: recommendations of the Association of European Paediatric Cardiology—CORRIGENDUM. Cardiol Young 28(4):620. https://doi.org/10.1017/S1047951117002700

    Article  PubMed  Google Scholar 

  20. Lawrenz W, Wilhelm M (2017) Resting ECG as screening tool for sudden cardiac death: PRO and CON. Swiss Sports Exerc Med 65(3):8–11

    Google Scholar 

  21. Williams EA, Pelto HF, Toresdahl BG, Prutkin JM, Owens DS, Salerno JC, Harmon KG, Drezner JA (2019) Performance of the American Heart Association (AHA) 14-point evaluation versus electrocardiography for the cardiovascular screening of high school athletes: a prospective study. J Am Heart Assoc 8(14):e12235. https://doi.org/10.1161/JAHA.119.012235

    Article  PubMed  PubMed Central  Google Scholar 

  22. Maron BJ, Thompson PD, Maron MS (2019) There is no reason to Adopt ECG s and abandon American Heart Association/American College of Cardiology history and physical screening for detection of cardiovascular disease in the young. J Am Heart Assoc 8(14):e13007. https://doi.org/10.1161/JAHA.119.013007

    Article  PubMed  PubMed Central  Google Scholar 

  23. Corrado D, Pelliccia A, Heidbuchel H, Sharma S, Link M, Basso C, Biffi A, Buja G, Delise P, Gussac I, Anastasakis A, Borjesson M, Bjørnstad HH, Carrè F, Deligiannis A, Dugmore D, Fagard R, Hoogsteen J, Mellwig KP, Panhuyzen-Goedkoop N, Solberg E, Vanhees L, Drezner J, Estes NAM, Iliceto S, Maron BJ, Peidro R, Schwartz PJ, Stein R, Thiene G, Zeppilli P, McKenna WJ (2010) Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J 31(2):243–259. https://doi.org/10.1093/eurheartj/ehp473

    Article  PubMed  Google Scholar 

  24. Drezner JA, Ackerman MJ, Anderson J, Ashley E, Asplund CA, Baggish AL, Börjesson M, Cannon BC, Corado D, Difiori JP, Fischbach P, Froelicher V, Harmon KG, Heidbuchel H, Marek J, Owens DS, Paul S, Pellicia A, Pruktin JM, Salerno JC, Schmied CM, Sharma S, Stein R, Vetter VL, Wilson MG (2013) Electrocardiographic interpretation in athletes: the ‘Seattle criteria’. Br J Sports Med 47:122–124. https://doi.org/10.1136/bjsports-2012-092067

    Article  PubMed  Google Scholar 

  25. Drezner JA, Sharma S, Bagish A, Papadakis M, Wilson MG, Pruktin JM, Gerche A, Ackerman MJ, Borjesson M, Salerno JC, Asif IM, Owens DS, Chung EH, Emery MS, Froelicher VF, Heidbuchek H, Adamuz C, Asplund CA, Cohen G, Harmon KG, Marek JC, Molossi S, Niebauer J, Pelto HF, Perez MV, Riding NR, Saarel T, Schmied CM, Shipon DM, Stein R, Vetter VL, Pellicia A, Corrado D (2017) International recommendations for electrocardiographic interpretation in athletes. Br J Sports Med 51:704–731. https://doi.org/10.1136/bjsports-2016-09733

    Article  PubMed  Google Scholar 

  26. Fudge J, Harmon KG, Owens DS et al (2014) Cardiovascular screening in adolescents and young adults: a prospective study comparing the pre-participation physical evaluation monograph 4th edition and ECG. Br J Sports Med 48:1172–1178

    Article  PubMed  Google Scholar 

  27. Harmon KG, Zigman M, Drezner JA (2015) The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: a systematic review/meta-analysis. J Electrocardiol 48:329–338. https://doi.org/10.1016/j.jelectrocard.2015.02.001

    Article  PubMed  Google Scholar 

  28. Asif IM et al (2013) Sudden cardiac death in young athletes: what is the role of screening? Curr Opin Cardiol 28:55–56

    Article  PubMed  Google Scholar 

  29. Menafoglio A, Di Valentino M, Segatto JM, Siragusa P, Pezzoli R, Maggi M, Romano GA, Moschovitis G, Wilhelm M, Gallino A (2014) Costs and yield of a 15-month preparticipation cardiovascular examination with ecg in 1070 young athletes in switzerland: Implications for routine ECG screening. Br J Sports Med 48:1157–1161

    Article  PubMed  Google Scholar 

  30. Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G (2006) Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 296:131593–131601

    Article  Google Scholar 

  31. Nistri S, Thiene G, Basso C et al (2003) Screening for hypertrophic cardiomyopathy inma young male military population. Am J Cardiol 91:1021–1023

    Article  PubMed  Google Scholar 

  32. Hill AC, Miyake CY, Grady S, Dubin AM (2011) Accuracy of interpretation of preparticipation screening electrocardiograms. J Pediatr 159:783–788

    Article  PubMed  Google Scholar 

  33. Chandra N, Bastiaenen R, Papadakis M et al (2014) The prevalence of ECG anomalies in young individuals; relevance to a nationwide cardiac screening program. J Am Coll Cardiol 63:2028–2034. https://doi.org/10.1016/j.jacc.2014.01.046

    Article  PubMed  Google Scholar 

  34. Koch S, Cassel M, Linné K, Mayer F, Scharhag J (2014) ECG and echocardiographic findings in 10–15-year-old elite athletes. Eur J Prev Cardiolog 21(6):774–781. https://doi.org/10.1177/2047487312462147

    Article  Google Scholar 

  35. Roberts WO, Löllgen H, Matheson GO, Royalty AB, Meeuwisse WH, Levine B, Hutchinson MR, Coleman N, Benjamin HJ, Spataro A, Debruyne A, Bachl N, Pgozzi F et al (2014) Advancing the preparticipation physical evaluation: An ACSM and FIMS joint consensus statement. Clin J Sport Med 24:442–447

    Article  PubMed  Google Scholar 

  36. Sharma S, Dezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, La Gerche A, Ackerman MJ, Borjesson M, Salerno JC, Asif IM, Owens DS, Chung EH, Emery MS, Froelicher VF, Heidbuchel H, Adamuz C, Asplund CA, Cohen G, Harmon KG, Marek JC, Molossi S, Niebauer J, Pelto HF, Perez MV, Riding NR, Saarel T, Schmied CM, Shipon DM, Stein R, Vetter VL, Pelliccia A, Corrado D (2018) International recommendations for electrocardiographic interpretation in athletes. Eur Heart J 39:1466–1480

    Article  PubMed  Google Scholar 

  37. Perrin T, Trachsel LD, Schneiter S, Menafoglio A, Albrecht S, Pirrello T, Eser P, Roten L, Gojanovic B, Wilhelm M (2017) Prevalence of abnormal electrocardiograms in swiss elite athletes detected with modern screening criteria. Swiss Med Wkly 146:w14376

    Google Scholar 

  38. Albiński M, Saubade M, Menafoglio A, Meyer P, Capelli B, Wilhelm M, Schmied C, Gabus V (2019) ECG screening in paediatric athletes: a multi-centre retrospective study in 891 Swiss athletes. Cardiovasc Med 22:w2041. https://doi.org/10.4414/cvm.2019.02041

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jannos Siaplaouras.

Ethics declarations

Interessenkonflikt

J. Siaplaouras, C. Apitz, P. Fritsch, M. Wilhelm und S. Kriemler geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Redaktion

A. Borkhardt, Düsseldorf

S. Wirth, Wuppertal

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Siaplaouras, J., Apitz, C., Fritsch, P. et al. Das 12-Kanal-Ruhe-EKG in der sportmedizinischen Untersuchung von Kindern und Jugendlichen. Monatsschr Kinderheilkd 167, 1157–1161 (2019). https://doi.org/10.1007/s00112-019-00796-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00112-019-00796-9

Schlüsselwörter

  • EKG
  • Plötzlicher Herztod
  • Sportmedizinische Untersuchung
  • Sportherz
  • Internationale Empfehlungen

Keywords

  • ECG
  • Sudden cardiac death
  • Sports medical examination
  • Athlete’s heart
  • International recommendations