Using ECGs to identify heart conditions in youth athletes, with Peace Madueme, MD

Florida’s upcoming Second Chance Act has placed new focus on the role of electrocardiogram (ECG) testing in identifying hidden cardiac conditions among young athletes. According to Peace Madueme, MD, chief of cardiology at Nemours Children’s Hospital in Orlando, these screenings—set to become mandatory for high school athletes beginning in the 2026-2027 school year—offer a vital supplement to the traditional sports physical.

“There are definitely certain conditions that, when you see them on an ECG, make a diagnosis,” said Madueme. “The simplest example I can give you is Wolff-Parkinson-White, which is a condition associated with having a very rapid and fast heartbeat. There’s a specific feature on an ECG that, when you see it, means they have the substrate, and they oftentimes need more therapy, whether it’s medication or a procedure called an ablation.”

Identifying silent cardiac conditions in young athletes

Although the incidence of such findings is relatively low, Madueme emphasized that even a few detected cases can be lifesaving.

“When you look at 500, 1000, or 2000 kids, there will be a few that get caught because they’re asymptomatic and just happen to have it. They’ve never had an ECG, and it finds it,” he said.

The Second Chance Act, signed into law in 2025, was designed to supplement the Florida High School Athletic Association’s standard presport physical, requiring an ECG to screen for cardiac abnormalities that could lead to sudden cardiac arrest. The measure honors Chance Gainer, a student-athlete who died after collapsing on the field due to an undiagnosed condition.

In a previous interview with Contemporary Pediatrics, Madueme discussed the Second Chance Act at greater length. Click here to watch.

How ECGs complement routine physicals

Madueme noted that although most ECG results in youth athletes are normal, the test is invaluable when interpreted alongside a detailed family history and physical examination.

“That’s why it’s a supplement to the sports physical—because it’s an additional tool,” he explained.

According to Madueme, ECGs provide pediatricians with 3 distinct advantages:

• Detecting silent or asymptomatic conditions that might otherwise go unnoticed
• Supporting early referral to cardiology for follow-up and potential intervention
• Enhancing confidence in clearance decisions for safe sports participation

Looking ahead: Florida as a model for the nation

Madueme acknowledged challenges in scaling the program statewide, citing resource and staffing limitations.

“There are issues with resources and being able to see and handle that amount of patients and ECGs—and who reads them, etc,” he said.

Still, he believes Florida’s implementation could set a national example. “I think how this goes in Florida will probably help with the rest of the nation in terms of whether this is something that can be done economically and logistically and without too much impact on the patients in terms of missing sports,” he said. “How that gets implemented is going to be the key.”

Reference

The Second Chance Act – Chance Gainer. Gulf Coast Schools. July 10, 2025. Accessed October 6, 2025. https://gulfcoschools.com/the-second-chance-act-chance-gainer/