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Benefits of cardiac screening examined after NHL player collapses


The Globe and Mail

...And many couldn’t help but wonder if they or their loved ones could also be at risk for sudden cardiac arrest while on the ice, field or court. Although rare, unsuspected sudden cardiac events cause about 500 deaths in people under the age of 40 each year in Canada. The situation involving Peverley, a professional athlete in the prime of his life, is a stark reminder that potentially deadly heart problems can strike anyone.

National Hockey League players, including Peverley, go through a rigorous medical exam on the first day of training camp each fall that includes advanced screening processes, such as electrocardiograms, for heart-related issues. But some argue that blanket screening should also be applied to the wider population, including anyone who plays organized sports, to mitigate possible risks.

It’s a highly charged, emotional issue with few easy answers.

In Italy, "pre-participation” screening is a way of life for young athletes who must submit to electrocardiograms, family history questions and other tests before they are cleared for play.

The screening is designed to catch heart abnormalities that could pose a risk for sudden cardiac arrest or other serious heart problems. Although the costs can add up and screening can be time-consuming for patients and doctors, the chance to save young lives justifies it, according to research presented to the 2011 European Society of Cardiology Congress.

But, along with being costly and cumbersome, testing every young person who wants to play sports is potentially ineffective or misleading, said Dr. Paul Dorian, a cardiologist at St. Michael’s Hospital and director of the division of cardiology at the University of Toronto, who specializes in rhythm disorders of the heart. For instance, screening could sideline a person from sports for life even though their risk of having a cardiac event is minute. And screening often can’t catch problems that may lead to sudden cardiac arrest.

"This is very controversial,” Dorian said.

"Even if we are prepared to invest a lot of time in trying to identify individuals who might be at risk, this is very hard to do and it’s often unsuccessful.”

Sudden cardiac events don’t only occur in athletes. But when they do, they are highly publicized because it’s surprising to see people in peak physical form suffer a devastating heart-related incident, Dorian said.

Despite the fact that Peverley, 31, was treated for a separate heart-related issue in the fall, it’s likely that the incident that caused his cardiac arrest Monday night was unrelated, according to Dorian.

In September, Peverley underwent a procedure to treat an atrial fibrillation and was given medication. He was later cleared for play. But early last week, some of his symptoms came back.

The type of cardiac arrest Peverley suffered is typically caused by ventricular fibrillation, which is characterized by extremely rapid, unco-ordinated beating of the heart. Unless treated with CPR and defibrillation, the condition is "uniformly fatal,” Dorian said.

"It’s very unlikely he’s ever had this before. Otherwise, they probably wouldn’t have let him play,” he said.

Pam Husband, executive director of the Canadian Sudden Arrhythmia Death Syndromes Foundation, said many experts in Canada remain divided on the issue of screening. But more awareness of the warning signs of sudden cardiac events, notably fainting and a family history, can encourage people to see their doctors and take steps to reduce their overall risks.

With files from James Mirtle


Published Tuesday, Mar. 11 2014, 11:12 PM EDT

Last updated Wednesday, Mar. 12 2014, 8:20 PM EDT

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