Cardiovascular Pre-participation Screening in Children and Adolescents

Sports participation is strongly encouraged in children and adolescents, but intense training at early ages may reveal hidden heart conditions that increase the risk of sudden cardiac death. Pre-participation evaluation aims to identify these conditions before sports practice. This observational study will evaluate children and adolescents enrolled in the São Paulo Olympic Program (Programa São Paulo Olímpico). All participants will undergo a structured medical interview, a standardized physical examination and a resting 12-lead electrocardiogram (ECG). Participants with borderline ECG findings, warning symptoms, abnormal physical examination findings or a suggestive personal or family history will also undergo a 3-minute step test (Harvard step test) with continuous ECG recording during exercise and recovery, in order to detect exercise-induced arrhythmias. The main goal is to estimate the prevalence of potentially pathological ECG findings in this population. The study will also describe warning signs in the medical history, abnormal physical examination findings, step test results, and the referrals and confirmed diagnoses during follow-up.

Inclusion Criteria: * Age under 18 years * Regular enrollment in organized sports in the São Paulo Olympic Program, with at least two training sessions per week * Informed consent signed by the legal guardian and assent signed by the participant * Availability to complete all study procedures (medical history, physical examination and resting electrocardiogram) Exclusion Criteria: * Inability to understand the study procedures * Refusal to participate by the legal guardian or the participant * Acute febrile illness in the 72 hours before data collection * Known structural heart disease under follow-up without medical clearance for sports practice * Previous abnormal electrocardiogram under active investigation * Known pregnancy