Pre-competition screening for cardiovascular disorders among athletes at the bali provincial national sports week: a cross-sectional study

Abstract

Sudden Cardiac Death (SCD) remains a significant risk among competitive athletes, who, despite being perceived as paragons of physical health, may harbor subclinical cardiovascular abnormalities that manifest fatally under peak exertion. This cross-sectional epidemiological study conducted pre-competition cardiovascular screenings on 95 athletes from the Bali Provincial contingent preparing for the National Sports Week on February 14, 2024, with the objective of determining the prevalence of cardiovascular disorders and identifying individuals requiring specialized clinical management. The three-stage screening protocol employed the 14-point American Heart Association checklist for structured clinical history and hereditary risk assessment, a comprehensive physical examination incorporating vital sign monitoring and cardiac auscultation, and 12-lead electrocardiography (ECG) interpreted by two independent cardiologists under a pre-established consensus protocol. Among the 95 participants (54.7% male; 71.6% aged 20–30 years), hypertension was identified in 8.4% of athletes. Rhythm analysis of 85 evaluable ECG recordings revealed normal sinus rhythm in 51.8%, sinus bradycardia in 40.0%, sinus arrhythmia in 7.1%, and atrial rhythm in 1.2%. Detailed ECG analysis of 15 athletes with significant findings identified Incomplete Right Bundle Branch Block (IRBBB) in 60.0%, Left Posterior Fascicular Block (LPFB) in 20.0%, Left Ventricular Hypertrophy (LVH) in 13.3%, and Premature Ventricular Contraction (PVC) Bigeminy in 6.7%. A total of 20 athletes (21.1%) were referred for specialized cardiology consultation. These findings demonstrate that a structured, multi-stage pre-participation screening protocol is effective in uncovering both physiological cardiac adaptations and potentially pathological conditions in elite athletes, underscoring the necessity of institutionalizing such programs as a standard pre-competition safety measure in Indonesian sports governance.