Cardiac evaluation of paediatric athletes

Paediatric athletes are not simply 'mini adults'. Most existing recommendations for cardiac screening in paediatric athletes are primarily based on evidence in adults and are designed for adult athletes. Paediatric-specific recommendations are needed due to the specifics of cardiac physiology, maturation and growth, age-related disease expression, modified diagnostic pathways, training adaptations, and to address relevant ethical considerations. This clinical consensus document from the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC) introduces specific advice for paediatric athletes for the first time, based on expert consensus, and where available, data from paediatric athlete populations. Members of the writing group voted anonymously on key advice statements, with ≥80% agreement required for consensus. All advice in this document applies to paediatric athletes aged <16 years, including those under 12 years of age. This document advises that cardiac screening of paediatric athletes with personal and family medical history, physical examination and 12-lead resting electrocardiogram (ECG) should be performed and should start no later than the age of 12 years. Implementing a screening programme requires ensuring the availability of necessary healthcare resources. One transthoracic echocardiogram may be appropriate to identify high-risk structural cardiac diseases not identifiable on ECG, provided appropriate infrastructure for baseline diagnostic assessments is in place. This document also includes suggested definitions of normal, borderline and abnormal ECG findings in paediatric athletes. Detailed advice is provided for further evaluation if suspicious findings are identified on initial tests. This document highlights that further research is required to optimise screening strategies, accurately assess and quantify the risk of sudden cardiac death and provide evidence-based eligibility recommendations for paediatric athletes with cardiac disease. It is also noted that increased opportunities for paediatric sports cardiology training are required to provide adequate medical care for the paediatric athlete population.

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Publication Details

Journal
European Heart Journal
Published
2026-04-01
DOI
https://doi.org/10.1093/eurheartj/ehag188
Citations
1
Primary Topic
Cardiovascular Effects of Exercise
Type
article
Field-Weighted Citation Impact
18.54

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Cardiac evaluation of paediatric athletes

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1 citations
European Heart Journal
Cardiovascular Effects of Exercise
18.54
article

Cardiac evaluation of paediatric athletes

Flavio D’Ascenzi, Antonio Pelliccia, Georgia Sarquella‐Brugada, Elena Cavarretta, Guido E. Pieles, M. Cecilia Gonzalez Corcia, David Niederseer, R Oberhoffer, Aneil Malhotra, Graham Stuart, Jessica Joan Orchard, Sabiha Gati, Alessandro Zorzi, Domenico Corrado, M Abela, Nathan R Riding, V Maestrini, Michael Papadakis, Stephan Gerling, Monica Tiberi, Guido Claessen, Elena Arbelo, Giovanni Di Salvo, Werner Budts, Josef Niebauer, Peter Fritsch, Silvia Castelletti, M Sanz-De La Garza, Gherardo Finocchiaro
article en
1 citations

Abstract

Paediatric athletes are not simply 'mini adults'. Most existing recommendations for cardiac screening in paediatric athletes are primarily based on evidence in adults and are designed for adult athletes. Paediatric-specific recommendations are needed due to the specifics of cardiac physiology, maturation and growth, age-related disease expression, modified diagnostic pathways, training adaptations, and to address relevant ethical considerations. This clinical consensus document from the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC) introduces specific advice for paediatric athletes for the first time, based on expert consensus, and where available, data from paediatric athlete populations. Members of the writing group voted anonymously on key advice statements, with ≥80% agreement required for consensus. All advice in this document applies to paediatric athletes aged <16 years, including those under 12 years of age. This document advises that cardiac screening of paediatric athletes with personal and family medical history, physical examination and 12-lead resting electrocardiogram (ECG) should be performed and should start no later than the age of 12 years. Implementing a screening programme requires ensuring the availability of necessary healthcare resources. One transthoracic echocardiogram may be appropriate to identify high-risk structural cardiac diseases not identifiable on ECG, provided appropriate infrastructure for baseline diagnostic assessments is in place. This document also includes suggested definitions of normal, borderline and abnormal ECG findings in paediatric athletes. Detailed advice is provided for further evaluation if suspicious findings are identified on initial tests. This document highlights that further research is required to optimise screening strategies, accurately assess and quantify the risk of sudden cardiac death and provide evidence-based eligibility recommendations for paediatric athletes with cardiac disease. It is also noted that increased opportunities for paediatric sports cardiology training are required to provide adequate medical care for the paediatric athlete population.

European Heart Journal
University of Siena (IT), Manchester Metropolitan University (GB), The University of Sydney (AU), Hospital Sant Joan de Déu Barcelona (ES), University of Padua (IT), St George's, University of London (GB), University of Malta (MT), Medical University of Graz (AT), Paracelsus Medical University (AT), Royal Brompton & Harefield NHS Foundation Trust (GB), University Hospitals Bristol NHS Foundation Trust (GB), St George’s University Hospitals NHS Foundation Trust (GB), Mater Dei Hospital (MT), Centre Hospitalier Universitaire Sainte-Justine (CA), University Hospital Regensburg (DE), University of Bristol (GB), Centro de Investigación en Red en Enfermedades Cardiovasculares (ES), Qatar Orthopaedic and Sports Medicine Hospital (QA), University Hospital of Zurich (CH), Lung Institute (US), Austrian Institute for Health Technology Assessment GmbH (AT), Centro de Investigación Biomédica en Red (ES), CK-CARE (CH), Bambino Gesù Children's Hospital (IT), Ospedale Santa Maria della Misericordia di Udine (IT), Azienda Socio Sanitaria Territoriale Lariana (IT), NIHR Bristol Cardiovascular Biomedical Research Unit (GB), Hartcentrum Hasselt (BE), ERN GUARD-Heart (NL), Institute of Sports Medicine and Science (JP), Cleveland Clinic London (GB), Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES), Hochgebirgsklinik Davos (CH), Digital Health Cooperative Research Centre (AU), University College London (GB), Imperial College London (GB), University of Regensburg (DE), Technical University of Munich (DE), Misericordia University (US), Universitat de Barcelona (ES), Sapienza University of Rome (IT), Hasselt University (BE), KU Leuven (BE)
National Health and Medical Research Council
Industry, innovation and infrastructure
Openalex Percentile: Top 1%
Cardiovascular Effects of Exercise
18.54
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