Should athletes have routine ECG -- tragedy involving enlarged cardiomyopathy (Thursday night)?

from Grand Rapids Press article (posted at MLive dot-com)

A 16-year-old star basketball player's sudden cardiac death brings home in a painful way an ongoing debate among medical professionals: Should all young athletes undergo electrocardiograms as part of their sports physicals?

The death of Wes Leonard, a star athlete who collapsed minutes after leading the Fennville basketball team to victory, was caused by dilated cardiomyopathy -- an enlarged heart -- that triggered an abnormal heartbeat, an autopsy showed. A Detroit-area cardiologist who provides free cardiac screenings to athletes says an ECG would likely have helped detect Leonard's heart condition.
"That story is chilling," said Dr. David Haines, the director of the heart rhythm center at Beaumont Hospital.
Although no one can say for certain, Haines believes an ECG would probably have revealed some irregularity. A follow-up echocardiogram -- an ultrasound test that shows a picture of the heart -- would have revealed Leonard's heart condition.
"The ECG is not very precise in that diagnosis, but it would have been very unusual for a person to have cardiomyopathy and have a totally normal ECG," Haines said.
Sudden cardiac death in athletes is extremely rare. Studies estimate it occurs in one in every 200,000 athletes. A 2009 report in Circulation: Journal of the American Heart Association found the rate of sudden cardiac deaths in young athletes was similar to that of deaths from lightning.
But when it occurs, it is shocking and heartbreaking because it strikes young, active, people who seem to be the picture of health.
The American Academy of Cardiology does not support routine ECGs for young athletes, in part, because it is considered an expensive way to detect a very small number of problems, said Dr. Ronald Grifka, chief of cardiology at Helen DeVos Children's Hospital. Also, not all heart conditions would be detected by the tests, and a number of minor problems would turn up that would bar many athletes from sports.
In Leonard's case, Dr. David Start, who performed the autopsy, questioned whether an ECG would have revealed his heart abnormality. ECGs are often given in a resting state, and Leonard's arrhythmia may only have been present during activity, he said.
"Sometimes the tests can detect a cardiac enlargement, but other times they don't," Start said.
However, ECGs are recommended for young athletes by the European Society of Cardiology and have been used routinely in Italy for 30 years. They reduced the number of sudden cardiac deaths by 89 percent, according to a 2006 report in the Journal of the American Medical Association.