American Academy of Pediatrics – Section on Cardiology and Cardiac Surgery

View all recommendations from this society

Released November 2, 2020

Do not routinely order a screening ECG as part of a sports preparticipation examination in asymptomatic, otherwise healthy patients with no personal or family history of cardiac disease.

Routine screening ECGs for preparticipation sports clearance are not currently recommended by the American Heart Association (AHA). Instead, it is recommended that the AHA’s 14-point screening guidelines, or the American Academy of Pediatrics’ “Preparticipation Physical Evaluation” be used in conjunction with a targeted personal history, family history, and thorough physical examination. The goal is to identify warning signs or signs that raise suspicion of cardiovascular diseases that place certain athletes at risk of sudden cardiac death. These individuals should be referred for further evaluation by a pediatric cardiologist who may order an ECG or an echocardiogram as part of the work-up.

Routine ECG screening of healthy pediatric patients with no personal or family history of cardiac disease has demonstrated a high false-positive rate and has not been found to reduce mortality from sudden cardiac death. In addition, it can also lead to unnecessary secondary evaluations. ECG screening should be performed in those patients with a strong family history of conditions likely to cause sudden cardiac arrest or death.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items
on this list or their individual situation should consult their physician.

How The List Was Created

This list was developed initially by faculty in Pediatric Cardiology at University Hospitals in Cleveland OH. It was then revised and approved by the AAP Section on Cardiology and Cardiac Surgery. After review by other AAP sections, the AAP Executive Committee granted final approval of the list.

AAP’s disclosure and conflict of interest policy can be found at


Maron BJ, Levine BD, Washington RL, Baggish AL, Kovacs RJ, Maron MS; American Heart Association, Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology; and American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 2: preparticipation screening for cardiovascular disease in competitive athletes. Circulation. 2015;132(22):e267-e272

Maron BJ, Friedman RA, Kligfield P, et al; American Heart Association, Council on Clinical Cardiology, Advocacy Coordinating Committee, Council on Cardiovascular Disease in the Young, Council on Cardiovascular Surgery and Anesthesia, Council on Epidemiology and Prevention, Council on Functional Genomics and Translational Biology, Council on Quality of Care and Outcomes Research; and American College of Cardiology. Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age). J Am Coll Cardiol. 2014; 64(14):1479-1514

Schmehil C, Malhotra D, Patel DR. Cardiac screening to prevent sudden death in young athletes. Transl Pediatr. 2017;6(3):199–206

American Academy of Pediatrics. Preparticipation Physical Evaluation. 5th Edition. Bernhardt DT, Roberts WO, eds. Itasca, IL: American Academy of Pediatrics; 2019