Cardiac screening Q&A with Dr Gary O'Driscoll

Following last weekend’s incident involving Fabrice Muamba, Arsenal.com caught up with Club Doctor, Dr Gary O'Driscoll, who explains just how stringent the Cardiac Screening Programme procedure is at Arsenal Football Club.

Since last Saturday when Fabrice Muamba collapsed at White Hart Lane, there has been a lot of media discussion regarding heart screening. When cardiac screening a player, what exactly are you looking for?
What we are looking to avoid is a condition called Sudden Cardiac Death. This is a non-specific term referring to the causes of cardiac arrest in young people. Although it is extremely rare, we do everything we possibly can, firstly to try and detect any potential problems in all our players, and then ensure that we are in a position to respond to a problem should one arise, as the medical team did so well at White Hart Lane.

A full screen includes multiple aspects comprising a full medical examination, past medical history, past family history and an Electrocardiogram (ECG), which looks at the electrical conduction pathways around the heart. Small stickers known as electrodes are placed on the player’s chest and the wires connect to an ECG machine while he lies still. We then repeat this test with all our players while they are pushed to their physical limit on a bike or treadmill to once again measure the electrical activity of the heart, but this time while it is working to near maximum capacity. An Echocardiogram (Echo) is then conducted, an Echo is an ultrasound test (such as offered to pregnant women), which examines the structure of the heart. All of these tests and their results are then interpreted by leading sports cardiologists.

How often do Arsenal players have their hearts screened?
Every Arsenal player has this battery of tests completed every year. This is done every pre-season, or when a player joins the Club. The frequency and depth of the screening programme at Arsenal is beyond the scope of that advised by the sports governing bodies at the present time, which indicate that screening should be done every two years. This is in no way a criticism of the governing body, as the evidence does not prove that more frequent screening is more effective. However, there is some conflicting guidance and we do work closely in conjunction with the advice of the Football Association.

Our cardiac screening procedure does not just apply to the first-team squad, every full-time player at the Club, including those in the Academy, must undergo these tests once a year, and this is something that the FA has helped to co-ordinate over the years.

How reliable are the tests?
Our cardiac screening procedure is extremely thorough, but unfortunately screening is not 100 per cent infallible and very rarely a cardiac arrest can still occur despite passing these tests, as happened with Fabrice Muamba. What is critical, as was shown in this case, was the immediate response and aftercare afforded to the player. The level of training for all the pitchside doctors and physiotherapists is extremely high and we all attend annual courses in Advanced Life Support, in order to develop our high level of expertise in dealing with these scenarios.

Allied to all the screening is the presence of the appropriate equipment in the hands of fully trained professionals giving every player the best chance of surviving these extremely rare and unfortunate incidents.

Ironically, in many ways one of the ‘best’ places for this to happen is at a Premier League stadium or at a training ground, where so many expert people and facilities are available. This is definitely the case at Arsenal, where alongside our highly-trained staff, we have Cardiac Defibrillators, Oxygen and Airways available at all times at Emirates Stadium, as well as having the same equipment available constantly at our training ground at London Colney.

What is very important to realise is that this is an extremely rare event and the screening process works very well. While research will continue in great depth to try and prevent any cardiac arrests it may be that very occasionally these tragic events will still happen. It remains critical that we are prepared to deal with the immediate management of such an incident as the medical teams so clearly were last weekend.

For further information go to the Cardiac Risk in the Young (CRY) website - http://www.c-r-y.org.uk