Sudden Cardiac Death in Athletes: Big Trouble, Not So Little Asia

The review by Dr. Halabchi, et al [1] is an excellent summary and reiteration of the importance of the addition of ECG screening to the pre-participation exam (PPE) for athletic competition. To pioneer this campaign in Asia, is a noble endeavor and is no small feat. As highlighted by this review, the general consensus for enforcing ECG as a requisite for participation varies greatly by the governing bodies making the suggestions and the demographic which they represent. The controversies most commonly discussed in the literature are the issues of lack of consensus for how to advise patients with ECG aberrations, false positive tests and the negative implications of such results; and cost effectiveness of mass screening. Not only does this manuscript briefly confront these topics, it also raises novel ideas regarding the unique milieu within the Asian cohort that may affect the risks for sudden cardiac death.