Athletic Screening

In 2007 we began performing ECGs as part of the pre-participation exam (PPE) for all Stanford athletes, in which athletes provided consent under Stanford IRB approval. The ECGs were digitized and entered into a database leading to three papers, the first reporting our experience with screening (Le, 2008) and then two others looking at the effect of gender (Mandic, 2009) and specific sport (Gademon, 2011) on the computerized measurements. We published a CPC monograph entitled, "Adding the ECG to the PPE" (Perez, 2009) and to justify adding the ECG, we performed a cost-efficacy analysis published in the Annals of Internal Medicine (Wheeler, 2009). The results of our study led the Athletic Department to mandate the ECG as part of the PPE in 2010. In 2010 we used a lapto analog to digital ECG system and our own software to perform the screening on Stanford collegiate athletes and the San Francisco 49ers. Our software is designed for screening athletes and the output states wheither an athlete needs further evaluation prior to participation or not. This differs from the available commercial interpretive programs which often give confusing statement when testing athletes. Our recommendation statement with a concensus of an international group of experts providing specific criteria for ECG diagnoses that require further evaluation prior to participation has been published.  Next are the beginnings of the evidence against the risk associated with Early Repolarization.

Selected Papers

2011
 

• Effect of Sport on computerized electrocardiogram Measurements in college athletes, Gademan, Myers, Ashley, et al.
• The Impact of Early Repolarization on ECG Screening, Leo et al (Clinical Journal Sports Medicine)
• Recommendations for Reading the Pre-Participation ECGs (Circulation)
• The Natural History of Early Repolarization in the Lateral Leads (AJC)
• The Prognostic Importance of Atrial Abnormalities (CJC)

2010/2009

• Adding an Electrocardiogram to the Pre-participation Examination in Competitive Athletes, Perez, Ashley, et al.
• Cost-Effectiveness of Preparticipation Screening for Prevention of Sudden Cardiac Death in Young Athletes, Wheeler, Ashley, et al.
• Defining the Limits of Athlete's Heart, Sedehi, Ashley, et al.
• Addition of the Electrocardiogram to the Preparticipation Examination of College Athletes, Le, Ashley, et al.
• Effect of Gender on computerized electrocardiogram Measurements in college athletes, Mandic, Ashley, et al,
• Dewey FE, Rosenthal D, Murphy DJ Jr, Froelicher VF, Ashley EA.  Does size matter? Clinical applications of scaling cardiac size and function for  body size. Circulation. 2008 Apr 29;117(17):2279-87.