Regular exercise has proven to be a healthy habit that decreases risk factors and atherosclerosis; however, it increases the risk of ventricular arrhythmias and sudden death in individuals with pre-existing cardiac diseases. Generalised pre-participation screening programmes are being increasingly implemented; however, their cost effectiveness has not yet been clearly established. More recently, data suggest that athlete's heart, secondary to long term endurance sport practice, may increase the incidence of arrhythmias, particularly atrial fibrillation (AF), atrial flutter, sinus node dysfunction, and eventually right ventricular tachycardia. Given the fact that an increasing number of individuals engage in regular endurance sport practice, it is certainly of great interest to define which recommendations for sport practice should be implemented in an individual patient and determine how best to manage arrhythmias in sport practitioners.#N##N#Sudden death among young athletes is uncommon, ranging from 0.5 to 3 per 100 000 per year.1 The prevalence of the underlying diseases in these cases remains controversial. In the US series, the major contributor to sudden death was hypertrophic cardiomyopathy (HCM) (figure 1),2 whereas in the Veneto series (northern Italy), right ventricular dysplasia (RVD) was the most prevalent disease. These differences were attributed to population prevalence of heart disease (RVD being highly prevalent in Italy) or to a more complete pre-participation screening policy in Veneto. In recent Australian necropsy studies, the authors did not find structural heart disease in most individuals. Therefore, a primary electrical abnormality was considered to be the leading cause. Although the exact prevalence of each abnormality is still under debate, it is clear that strenuous exercise in young individuals may precipitate fatal arrhythmias and sudden death in a number of cardiac structural diseases such as HCM, congenital coronary abnormalities, RVD, Wolff–Parkinson–White syndrome, channelopathies, etc. While the cost effectiveness of a generalised pre-participation screening for …