Improving the Odds for High-risk Athletes

An update from UW Medicine faculty Kimberly Harmon, M.D.

Colleagues, sports medicine physicians and sports cardiology experts Kim Harmon, M.D., and Jon Drezner, M.D., Fel. ’00, are team physicians for the University of Washington and leaders in standardizing ECG screenings for athletes.
Photo: Clare McLean

When we think of athletes, we think of good health — so it’s surprising and tragic when an athlete dies on the field from sudden cardiac arrest (SCA). On New Year’s Eve in 2002, the issue really hit home for me: Kayla Burt, a UW basketball athlete, had an SCA at home. She survived — she was resuscitated by her teammates, and Medic One responded promptly — but it galvanized me to better understand SCA. It turns out that SCA occurs in 1 of every 50,000 athletes, and the risk for basketball players is a lot higher: as high as 1 in 3,000.

The key to stopping SCA is figuring out which athletes have potentially dangerous cardiovascular disease before it strikes. Unfortunately, standard sports physicals don’t work: according to one study, there’s a 99-percent chance that problems will NOT be detected.

In response, many countries try to improve the odds by using an electrocardiogram (ECG, EKG) in addition to a history and physical. ECGs can detect electrical or structural heart disease that might lead to SCA, but interpreting them can be complicated. It’s not so surprising that different countries have developed different ECG-reading methods. And that ECGs, if misread, can lead to too many false positives, requiring additional and expensive testing.

Recently, we took a monumental step forward in protecting youth athletes. The American Medical Society for Sports Medicine, FIFA and the NCAA sponsored the Summit on ECG Interpretation in Athletes, chaired by Jon Drezner, M.D., Fel. ’00, director of the UW Medicine Center for Sports Cardiology. Experts in sports cardiology, hailing from the U.S. (several from UW Medicine), the United Kingdom, Qatar, Brazil, Sweden, Austria, Australia, Belgium and Switzerland gathered in Seattle this February to create an international consensus statement on ECG interpretation in athletes.

We had to agree on how serious certain ECG abnormalities were, and we had to come to a consensus on how to evaluate and follow up on these findings. There were disagreements, but Jon kept everyone focused. Ultimately, we produced visuals and guidelines that will be published in journals around the world, and training materials that teach physicians how to read ECGs will be updated with the new, improved criteria. These criteria are based, in part, on the ECG screenings we do for youth athletes at the UW Medicine Sports Medicine Center located at Husky Stadium.

Not long ago, Brian Hainline, M.D., the NCAA’s chief medical officer, recommended ECG screenings for high-risk athletes. There’s a definitive move toward more screening, and we need to know how to do it well. This summit, led by UW Medicine physicians to create new standards, was a big step forward.

If you are interested in youth athlete screening, contact 206.520.5000.

 

Dr. Harmon is a professor in the departments of family medicine and orthopaedics and sports medicine, section head of the UW Medicine Sports Medicine Center, and a team physician for the University of Washington.

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