Guidelines from the American Heart Association (AHA) (endorsed by the American College of Cardiology) and the European Society of Cardiology (ESC), both recommend a screening before sports participation, but the Americans favor a detailed medical history combined with a physical examination only, while the Europeans favor the addition of the 12–lead ECG.

The controversy was evident in the results of a poll conducted during a debate session at the AHA meeting last year, which were published this week in the New England Journal of Medicine by James Colbert, MD, of Harvard Medical School.

Of the audience members who voted –– an unscientific sample, to be sure –– 70% favored some type of screening for cardiac disease in young athletes. And in a scenario where screening was already a foregone conclusion, 60% said it should include an ECG. A similar online poll on the NEJM website was even more informative, showing that the differences in opinion exist on both sides of the Atlantic.

Of the 1,266 people who voted on the site –– again, not a scientific sample –– 18% didn’t want any mandatory screening, 24% wanted screening with a medical history and physical exam, and 58% favored screening that included an ECG. The percentage of voters who endorsed an ECG was higher among Europeans than among Americans (66% versus 45%), but that still indicates a substantial amount of controversy regardless of geography.