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3006 Cat: Sudden death PREVENTION OF SUDDEN CARDIAC DEATH DURING SPORTS: THE POWER OF PRE-PARTICIPATION SCREENING D. Corrado University of Padova, Padova, Italy Sudden death during sports is often the first and definitive manifestation of an underlying cardiovascular disease. Medical evaluation before competition offers the potential to detect still asymptomatic athletes with life-threatening heart diseases and to protect them from sudden cardiac death (SCD). The risk of SCD in young people engaged in regular training and athletic competition has been estimated to be approximately three times the risk among their nonathletic counterparts. Arrhythmic cardiac arrest may be precipitated by the interaction between exercise-induced adrenergic stimulation and underlying cardiovascular diseases, such as cardiomyopathies (mostly hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy) and cardiac ion-channel disorders. A positive family history, an abnormal physical examination, or premonitory symptoms are present in only a minority of young competitive athletes who die suddenly — with sudden cardiac arrest often the first manifestation of previously unsuspected heart disease. Preparticipation screening that relies solely on medical history and physical examination is of only marginal value for the detection of athletes at risk for SCD. The addition of ECG substantially enhances the power of screening for early detection of the leading causes of SCD, which are commonly manifested as ECG abnormalities. The analysis of data coming from the long-running Italian experience indicates that ECG screening has provided adequate sensitivity and specificity for detection of lethal cardiomyopathy or arrhythmias and has led to substantial reduction of mortality of young competitive athletes by approximately 90%. The Italian screening program was feasible thanks to the National Health System, which is developed in terms of health care and prevention services and because of the limited costs of cardiovascular evaluation in the setting of a mass program. On the basis of current scientific evidence the implementation of a mass-screening program aimed to prevent athletic-field sudden cardiac death should be at least carefully considered by public health administrators worldwide.