In 1982, a nationwide program of preparticipation screening of all individuals 
embarking in competitive sports activity was launched in Italy. The screening 
protocol includes athlete's personal and family history, physical examination, 
and twelve-lead electrocardiogram (ECG) as first-line examination; additional 
tests such as echocardiography or exercise testing are requested only for 
subjects who have positive findings at the initial evaluation. This screening 
algorithm, which has been used for preparticipation evaluation of millions of 
Italian athletes over a period of > 25 years has provided adequate sensitivity 
and specificity for detection of athletes affected by potentially dangerous 
cardiomyopathy or arrhythmia at risk of athletic-field death and has led to 
substantial reduction of mortality of young competitive athletes (by 
approximately 90%), mostly by preventing sudden death from cardiomyopathy.