The role and efficacy of ECG screening in assessing fitness to dive in military divers: implications of sports medicine standards

Introduction: Diving necessitates significant physiological adaptations, particularly within the cardiopulmonary system. Resting electrocardiograms (ECGs) are widely used in fitness to dive assessments, but their effectiveness in healthy young divers remains unclear. This study assessed the impact of applying sports medicine ECG criteria compared to traditional clinical standards, aiming to reduce (unnecessary) referrals to a cardiologist without compromising diver safety. Methods: In this retrospective study covering 10 years, ECGs from Royal Netherlands Navy divers were analysed. Abnormal ECGs identified by clinical criteria between 2010 and 2019 were re-evaluated using international sports medicine ECG criteria. A control group of normal ECGs was matched based on demographic factors. Statistical analyses were performed using Pearson’s chi-squared and Fisher’s exact test, with significance set at P < 0.05. Results: Of a total of 3,020 ECGs, 156 were classified as abnormal by clinical criteria. Reassessment using sports medicine standards reduced the number requiring further investigation by 85.9%. In the control group, 1.0% of previously unremarkable ECGs were identified as requiring further investigation upon reassessment. Conduction disorders and rhythm disturbances were the most common findings. Conclusions: The findings of this study suggest that the application of sports medicine ECG interpretation criteria effectively reduces the number of ECGs requiring further investigation, thereby minimising referrals and associated costs. These results advocate for a re-evaluation of routine ECG screening practices in fitness to dive assessments in military divers, promoting a more tailored approach for this specific group.