Cardiac evaluation of paediatric athletes: A clinical consensus statement of the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC)

Guido E Pieles; Elena Cavarretta; Jessica J Orchard; Mark Abela; Elena Arbelo; Werner Budts; Silvia Castelletti; Guido Claessen; Domenico Corrado; Giovanni Di Salvo; Gherardo Finocchiaro; Peter Fritsch; Sabiha Gati; Stephan Gerling; M Cecilia Gonzalez-Corcia; Aneil Malhotra; Viviana Maestrini; Josef Niebauer; David Niederseer; Michael Papadakis; Renate Oberhoffer; Antonio Pelliccia; Nathan Riding; María Sanz-de la Garza; Georgia Sarquella-Brugada; Sanjay Sharma; Alan Graham Stuart; Monica Tiberi; Alessandro Zorzi; Flavio D’Ascenzi

doi:10.1093/eurheartj/ehag188

Cardiac evaluation of paediatric athletes: A clinical consensus statement of the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC)

Guido E Pieles^*, Elena Cavarretta^*, Jessica J Orchard, Mark Abela, Elena Arbelo, Werner Budts, Silvia Castelletti, Guido Claessen, Domenico Corrado, Giovanni Di Salvo, Gherardo Finocchiaro, Peter Fritsch, Sabiha Gati, Stephan Gerling, M Cecilia Gonzalez-Corcia, Aneil Malhotra, Viviana Maestrini, Josef Niebauer, David Niederseer, Michael PapadakisRenate Oberhoffer, Antonio Pelliccia, Nathan Riding, María Sanz-de la Garza, Georgia Sarquella-Brugada, Sanjay Sharma, Alan Graham Stuart, Monica Tiberi, Alessandro Zorzi, Flavio D’Ascenzi

^*Corresponding author for this work

Research output: Contribution to journal › Review article (Academic Journal) › peer-review

Abstract

Paediatric athletes are not simply ‘mini adults’. Most existing recommendations for cardiac screening in paediatric athletes are primarily based on evidence in adults and are designed for adult athletes. Paediatric-specific recommendations are needed due to the specifics of cardiac physiology, maturation and growth, age-related disease expression, modified diagnostic pathways, training adaptations, and to address relevant ethical considerations. This clinical consensus document from the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC) introduces specific advice for paediatric athletes for the first time, based on expert consensus, and where available, data from paediatric athlete populations. Members of the writing group voted anonymously on key advice statements, with ≥80% agreement required for consensus. All advice in this document applies to paediatric athletes aged

Original language	English
Article number	ehag188
Pages (from-to)	2561-2583
Number of pages	23
Journal	European Heart Journal
Volume	47
Issue number	21
Early online date	9 Apr 2026
DOIs	https://doi.org/10.1093/eurheartj/ehag188
Publication status	E-pub ahead of print - 9 Apr 2026

Bibliographical note

Publisher Copyright:
© The Author(s) 2026.

Keywords

Screening
Paediatric athletes
Sudden cardiac death
Electrocardiogram

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Pieles, G. E., Cavarretta, E., Orchard, J. J., 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, M. C., Malhotra, A., Maestrini, V., Niebauer, J., Niederseer, D., ... D’Ascenzi, F. (2026). Cardiac evaluation of paediatric athletes: A clinical consensus statement of the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC). European Heart Journal, 47(21), 2561-2583. Article ehag188. Advance online publication. https://doi.org/10.1093/eurheartj/ehag188

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title = "Cardiac evaluation of paediatric athletes: A clinical consensus statement of the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC)",

abstract = "Paediatric athletes are not simply {\textquoteleft}mini adults{\textquoteright}. Most existing recommendations for cardiac screening in paediatric athletes are primarily based on evidence in adults and are designed for adult athletes. Paediatric-specific recommendations are needed due to the specifics of cardiac physiology, maturation and growth, age-related disease expression, modified diagnostic pathways, training adaptations, and to address relevant ethical considerations. This clinical consensus document from the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC) introduces specific advice for paediatric athletes for the first time, based on expert consensus, and where available, data from paediatric athlete populations. Members of the writing group voted anonymously on key advice statements, with ≥80\% agreement required for consensus. All advice in this document applies to paediatric athletes aged",

keywords = "Screening, Paediatric athletes, Sudden cardiac death, Electrocardiogram",

author = "Pieles, \{Guido E\} and Elena Cavarretta and Orchard, \{Jessica J\} and Mark Abela and Elena Arbelo and Werner Budts and Silvia Castelletti and Guido Claessen and Domenico Corrado and \{Di Salvo\}, Giovanni and Gherardo Finocchiaro and Peter Fritsch and Sabiha Gati and Stephan Gerling and Gonzalez-Corcia, \{M Cecilia\} and Aneil Malhotra and Viviana Maestrini and Josef Niebauer and David Niederseer and Michael Papadakis and Renate Oberhoffer and Antonio Pelliccia and Nathan Riding and \{Sanz-de la Garza\}, Mar{\'i}a and Georgia Sarquella-Brugada and Sanjay Sharma and Stuart, \{Alan Graham\} and Monica Tiberi and Alessandro Zorzi and Flavio D{\textquoteright}Ascenzi",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2026.",

year = "2026",

month = apr,

day = "9",

doi = "10.1093/eurheartj/ehag188",

language = "English",

volume = "47",

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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 2026, 'Cardiac evaluation of paediatric athletes: A clinical consensus statement of the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC)', European Heart Journal, vol. 47, no. 21, ehag188, pp. 2561-2583. https://doi.org/10.1093/eurheartj/ehag188

Cardiac evaluation of paediatric athletes: A clinical consensus statement of the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC). / Pieles, Guido E; Cavarretta, Elena; Orchard, Jessica J et al.
In: European Heart Journal, Vol. 47, No. 21, ehag188, 09.04.2026, p. 2561-2583.

Research output: Contribution to journal › Review article (Academic Journal) › peer-review

TY - JOUR

T1 - Cardiac evaluation of paediatric athletes

T2 - A clinical consensus statement of the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC)

AU - Pieles, Guido E

AU - Cavarretta, Elena

AU - Orchard, Jessica J

AU - Abela, Mark

AU - Arbelo, Elena

AU - Budts, Werner

AU - Castelletti, Silvia

AU - Claessen, Guido

AU - Corrado, Domenico

AU - Di Salvo, Giovanni

AU - Finocchiaro, Gherardo

AU - Fritsch, Peter

AU - Gati, Sabiha

AU - Gerling, Stephan

AU - Gonzalez-Corcia, M Cecilia

AU - Malhotra, Aneil

AU - Maestrini, Viviana

AU - Niebauer, Josef

AU - Niederseer, David

AU - Papadakis, Michael

AU - Oberhoffer, Renate

AU - Pelliccia, Antonio

AU - Riding, Nathan

AU - Sanz-de la Garza, María

AU - Sarquella-Brugada, Georgia

AU - Sharma, Sanjay

AU - Stuart, Alan Graham

AU - Tiberi, Monica

AU - Zorzi, Alessandro

AU - D’Ascenzi, Flavio

PY - 2026/4/9

Y1 - 2026/4/9

N2 - Paediatric athletes are not simply ‘mini adults’. Most existing recommendations for cardiac screening in paediatric athletes are primarily based on evidence in adults and are designed for adult athletes. Paediatric-specific recommendations are needed due to the specifics of cardiac physiology, maturation and growth, age-related disease expression, modified diagnostic pathways, training adaptations, and to address relevant ethical considerations. This clinical consensus document from the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC) introduces specific advice for paediatric athletes for the first time, based on expert consensus, and where available, data from paediatric athlete populations. Members of the writing group voted anonymously on key advice statements, with ≥80% agreement required for consensus. All advice in this document applies to paediatric athletes aged

AB - Paediatric athletes are not simply ‘mini adults’. Most existing recommendations for cardiac screening in paediatric athletes are primarily based on evidence in adults and are designed for adult athletes. Paediatric-specific recommendations are needed due to the specifics of cardiac physiology, maturation and growth, age-related disease expression, modified diagnostic pathways, training adaptations, and to address relevant ethical considerations. This clinical consensus document from the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC) introduces specific advice for paediatric athletes for the first time, based on expert consensus, and where available, data from paediatric athlete populations. Members of the writing group voted anonymously on key advice statements, with ≥80% agreement required for consensus. All advice in this document applies to paediatric athletes aged

KW - Screening

KW - Paediatric athletes

KW - Sudden cardiac death

KW - Electrocardiogram

U2 - 10.1093/eurheartj/ehag188

DO - 10.1093/eurheartj/ehag188

M3 - Review article (Academic Journal)

C2 - 41967042

SN - 0195-668X

VL - 47

SP - 2561

EP - 2583

JO - European Heart Journal

JF - European Heart Journal

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Pieles GE, Cavarretta E, Orchard JJ, Abela M, Arbelo E, Budts W et al. Cardiac evaluation of paediatric athletes: A clinical consensus statement of the European Association of Preventive Cardiology (EAPC) of the ESC and the Association for European Paediatric and Congenital Cardiology (AEPC). European Heart Journal. 2026 Apr 9;47(21):2561-2583. ehag188. Epub 2026 Apr 9. doi: 10.1093/eurheartj/ehag188