Cardiac evaluation of paediatric athletes
Regular physical activity and sports are very important for the healthy physical, emotional and social development of children and adolescents, and most young people can participate safely. However, a small number of children may have an unknown or not yet detected heart condition that increases the risk of serious heart rhythm disorders or sudden cardiac arrest during exercise. At the same time, the normal changes that occur in an athlete’s heart during growth and training can sometimes look like heart disease, making an examination by a heart specialist particularly important.
This document agreed on by a group of experts provides practical recommendations to help healthcare professionals examine young athletes accurately and consistently across Europe. It highlights that cardiac assessment should always be adapted to the individual child, taking into account their age, level of growth and maturity, symptoms, family history and the type and intensity of sports they practise. The document explains how medical tests such as the electrocardiogram (ECG), echocardiography (ultrasound of the heart) and, when appropriate, more detailed heart scans (like e.g. MRI) or tests that look for inherited conditions can help tell the difference between normal athletic adaptation and a hidden disease of the heart or blood vessel. Importantly, the document also emphasizes that most findings in healthy young athletes are harmless and should not lead to unnecessary restrictions from sports.
Developed through a partnership between the European Reference Networks for Rare or Low Prevalence Complex Cardiac Diseases (ERN GUARD-Heart), the Association for European Paediatric and Congenital Cardiology (AEPC) and the European Society of Cardiology (ESC), these recommendations combine the knowledge and experience of leading specialists from across Europe.
The recommendations also promote making decisions together involving healthcare professionals, young athletes and their families. The main aim is to identify children who really need further investigation or treatment while avoiding unnecessarily preventing children from taking part in sports, allowing as many children as possible to enjoy the long-term physical, psychological and social benefits of exercise safely.
Pieles GE, Cavarretta E, Orchard JJ, Abela M, Arbelo E, Budts W, Castelletti S, Claessen G, Corrado D, Di Salvo G, Finocchiaro G, Fritsch P, Gati S, Gerling S, Gonzalez-Corcia MC, Malhotra A, Maestrini V, Niebauer J, Niederseer D, Papadakis M, Oberhoffer R, Pelliccia A, Riding N, Sanz-de la Garza M, Sarquella-Brugada G, Sharma S, Stuart AG, Tiberi M, Zorzi A, D’Ascenzi F. Cardiac evaluation of paediatric athletes. Eur Heart J. 2026 Jun 2;47(21):2561-2583. doi: 10.1093/eurheartj/ehag188. PMID: 41967042; PMCID: PMC13225883.
Prepared by Georgia Sarquella-Brugada and Ruth Biller