Outcomes of pre-participation cardiac screening in elite rugby league athletes in england
Outcomes of pre-participation cardiac screening in elite rugby league athletes in england
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Original abstract
Abstract Background Pre-participation cardiac screening (PPCS) plays an important role in detecting underlying cardiovascular abnormalities that may predispose athletes to sudden cardiac death (SCD) and is advocated by multiple sporting governing bodies to mitigate the risk of such events. Purpose A PPCS programme was undertaken aligned with the English Rugby Football League (RFL) mandatory policy. We aimed to investigate the percentage of athletes that required additional investigations and to demonstrate the prevalence of cardiac abnormalities. Methods From January through August 2025, 805 (669 male, 136 female) elite athletes aged 16-35 underwent PPCS within the RFL cardiac screening programme. This consisted of a cardiac screening questionnaire and 12-lead ECG. An echocardiogram was carried out during PPCS in the presence of an abnormal 12-lead ECG based on international screening guidelines [1] or abnormal questionnaire. Additional follow-up assessment took place within a Sports Cardiology clinic as required. Results Of the 805 athletes screened, 779 had a normal screening (651 male, 128 female). From the 26 (3.2%) athletes with abnormal screening, 13 (1.0% male, 4.4% female) had an abnormal questionnaire, 12 (1.4% male, 1.5% female) had an abnormal ECG and 1 (<.1% male) had both an abnormal questionnaire and ECG. Abnormal findings on ECG included abnormal T-wave inversion (n = 10), ventricular ectopy (n = 2) and short PR interval with delta waves (n=1). The 26 athletes with abnormal screening underwent echocardiography. Eleven of the 26 had an abnormal echocardiogram, with findings of mild mitral regurgitation (n = 4), hypertrophic cardiomyopathy (n = 1), left (n = 2) and right (n = 1) ventricular functional abnormalities, papillary muscle thickening (n = 1) and congenital abnormalities (n = 2). Fifteen of the 26 had a normal echocardiogram of which 6 were still referred to secondary care due to ECG/questionnaire abnormalities which identified Wolf-Parkinson-White (WPW) syndrome (n = 1) and abnormal ventricular ectopic burden (n = 1) with no abnormalities detected in the remainder (n = 4). Overall, there was a 0.37% prevalence of cardiac disorders linked to SCD, a 0.75% prevalence of valvular and congenital disorders and 1.6% of athletes presented with concerning symptoms. All athletes have returned to competitive action, 14 are under long term follow up and 1 underwent successful ablation for WPW. Conclusion In a cohort of elite RFL athletes, 3.2% required follow-up after routine PPCS. In fitting with previous research within soccer players within the United Kingdom, there was a 0.37% prevalence of cardiac disorders linked to SCD with 0.75% prevalence of valvular or congenital abnormalities and therefore these data justify the importance of mandatory PPCS in RFL athletes.For image description, please refer to the figure legend and surrounding text.