Accuracy of the "International Criteria" for ECG screening in athletes in comparison with previous published criteria: rationale and design of a diagnostic meta-analysis.

INTRODUCTION The impact of the 'International Criteria' for ECG interpretation in athletes has further improved the diagnostic accuracy of the 12-lead ECG use for pre-participation screening (PPS) and these criteria have been evaluated in different populations of athletes and settings proving good results. EVIDENCE ACQUISITION We aim to perform a comprehensive review of the use of the 'International Criteria' for ECG interpretation in athletes, stemming from a systematic review to diagnostic meta-analysis, limiting our inclusion only to observational studies to determine the diagnostic accuracy of ECG for detecting cardiac anomalies related to sudden cardiac death in athletes. EVIDENCE SYNTHESIS This meta-analysis is expected to include several important studies related to PPS on different populations of athletes comparing different ECG criteria and detail important data on the diagnostic accuracy of ECG in PPS. Furthermore, we intend to highlight the advantage of using ECG in PPS. CONCLUSIONS The present diagnostic meta-analysis results will aid sports medicine physicians and cardiologist in adhering to the most accurate criteria for ECG evaluation in athletes and it may help to solve controversies aroused regarding the excess cost of ECG in PPS related to the amount of false positive cases.