Preparticipation screening in athletes, the role of sports cardiology and the impact of the camera

Sports medicine has been receiving increased exposure in communication media for a number of reasons. First, the mass introduction of social media and smartphones has dramatically increased the impact of health-related incidents, in particular cardiac arrests, occurring during sporting events [1]. Such catastrophes are exceedingly rare, but there are countless cameras present at sporting events. Current mass media enable eyewitnesses to distribute the footage instantly. Images of these dramatic events can go ‘viral’ within hours [2]. Second, new screening techniques, such as magnetic resonance imaging (MRI) and genetic testing, have increased our knowledge about abnormalities that may be associated with an increased risk of arrhythmias [3, 4]. These new techniques did increase our ability to identify individuals who are at a high risk, but also introduced new uncertainties. The relevance of new findings is frequently unknown, and the risk of a false positive test result (i. e. an abnormal finding without a real increase in the risk of fatal arrhythmia) is real and present. Abnormal test results associated with potentially life-threatening arrhythmias often imply disqualification for the athlete involved. The impact is tremendous, their career as an athlete may be over. Third, the availability of new treatments, including implantable defibrillators, has spurred discussions whether or not athletes are able to engage in competitive sports with these devices or with other treatments [5, 6]. Defibrillators do not prevent events, but increase the probability of survival should a cardiac arrest occur. Sports clubs wish to know exactly what the risks are when they hire a professional athlete to play for them. Fourth, the countless cameras that follow sporting events also record the responses by health professionals in case of a suspected or known cardiac arrest [1]. Their skills and behaviour have become