The ARENA Project
The Australasian Registry of Electrocardiograms in National Athletes (ARENA) collects and centralises cardiac screening data from sporting organisations across Australasia. It is led by researchers at the University of Sydney, in collaboration with other national and international experts, and hosted by the South Australian Health and Medical Research Institute (SAHMRI) Registry Centre. The ARENA study was launched in 2023, initially in Australia, with New Zealand to follow.
Sudden cardiac death (SCD) in athletes is a rare but tragic event. Cardiac screening of elite athletes for conditions associated with SCD is now widely recommended by leading bodies. Screening generally includes a personal and family history and a physical examination, together with a resting 12-lead electrocardiogram (ECG).
All elite sports in Australia and New Zealand conducting cardiac screening of athletes (including ECG) are eligible to participate. ARENA works closely with participating sporting organisations that can use this registry to improve the quality of their cardiac screening programs and provide better cardiac care for young athletes.
Our research team
- Associate Professor Jessica Orchard, chief investigator
- Professor Andre La Gerche, sports cardiologist and imaging specialist
- Associate Professor Hari Raju, cardiologist and electrophysiologist
- Professor Rajesh Puranik, cardiologist and cMRI expert
- Dr Simon Eggleton, cardiologist and imaging expert
- Mr Angus Davis, PhD candidate and cardiac nurse
- Dr Bruce Hamilton (NZ), sports physician
- Professor Rob Doughty (NZ), cardiologist
- Professor Jonathan Drezner (USA), sports physician and registry expert
- Professor John Orchard, sports physician
- Investigators & clinical advisors
- SAHMRI team including data managers, registry managers and biostatisticians
- Consumer/athlete representatives
- Representatives from participating sports, including the Australian Institute of Sport
Research & recent highlights
- Isolated Anterior T‐Wave Inversion in Elite Athletes: Prevalence and Clinical Relevance by Sex and Sporting Discipline (2025, J Am Heart Assoc) and accompaying editorial Anterior T‐Wave Inversion Pattern in Female Athletes: Is It Time to Rewrite the Playbook? (2025, J Am Heart Assoc)
- Rationale and Design of the Australasian Registry of Screening ECGs in National Athletes (ARENA) Project (2024, J Am Heart Assoc)
- Clinical outcomes of 10 years of cardiac screening in elite New Zealand athletes (2023, JSAMS)
- Orchard Sports Injury and Illness Classification System (OSIICS) Version 15 (2024, J Sport Health Sci)
- Sheffield Shield Cricketers Live Longer than the Age-Matched General Australian Male Population (2023, Indian J Orthop)
- Cardiac Screening and Prevention of Other Cardiac Emergencies in Cricket (2023, J Postgrad Med Edu Res)
- Comparison of methods for correcting QT interval in athletes and young people: a systematic review (2023, Clin Cardiol)
- Analysis of athlete QT intervals by age: Fridericia and Hodges heart rate corrections outperform Bazett for athlete ECG screening (2022, J Electrocardiol)
- The impact of ethnicity on athlete ECG interpretation: a systematic review (2022, J Cardiovasc Dev Dis)
- Use of a smartphone electrocardiogram to diagnose arrhythmias during exercise in athletes: a case series (2022, Eur Heart J Case Rep)
- Reduced death rates of elite Australian Rules footballers compared to age-matched general population (2022, JSAMS)
- Audit of a cardiac screening policy for elite Australian cricketers (2020, JSAMS)
- ECG-based cardiac screening programs: Legal, ethical, and logistical considerations (2019, Heart Rhythm)
Registry information
The ARENA project is funded by an Australian Government National Health and Medical Research Council (NHMRC) Investigator Grant and has ethical approval from the University of Sydney Human Research Ethics Committee (Project No. 2023/551) and the Australian Institute of Sport Ethics Committee (Ethics approval number 20240601). ARENA is endorsed by the Australasian College of Sport & Exercise Physicians and Sports Medicine Australia.
The ARENA project aims to provide long-term international data to improve our understanding of:
- the prevalence of conditions associated with SCD in screened athletes;
- the accuracy of ECG interpretation across different groups (e.g. athletes of various ethnicities, ages and sex);
- the bounds of normal cardiac adaptations to exercise across athletes from different Australasian sports to provide relevant benchmarks for normal athlete ECG features and accurate interpretation; and
- major cardiovascular outcomes of screened athletes.
The ARENA Project was declared a federal quality assurance activity in 2025 under the Health Insurance Act 1973 (Cth). Known as'qualified privilege', this legislation aims to encourage clinicans and organisations to participate in quality improvement activities. Qualified privilege protection prohibits the disclosure of information which is known solely as a result of the ARENA activities and prohibits disclosure (even to a Court) of any documents created solely for ARENA. It also protects confidentiality of athletes and clinicians involved by prohibiting disclosure of identifying information and protects participants in ARENA from civil liability as a result of participation.
ARENA is listed on the Australian Register of Clinical Registries.
Full details are available in the ARENA project protocol, published in the Journal of the American Heart Association (2024).
Written consent is provided by sporting organisations. No written consent is required from individual athletes.
Data is collected from most sporting organisations as follows:
- An initial collection of retrospective data (completed screenings) under a waiver of consent; and
- Ongoing collection of prospective data (future screenings) using an opt-out consent process where athletes are informed about the registry during screening.
All data collected from the Australian Institute of Sport is done under an opt-out process.
An athlete can opt-out at any time if desired (see ‘Participant materials’ for more details).
Data on athlete screening results will be collected directly from participating sporting organisations. The data will be deidentified and securely stored and athletes will not be identifiable in any publications.
Data will include some demographic information (including name, sex, date of birth, sport/distance/event), together with the date and result of each cardiac screening, a copy of the ECG and any other cardiac tests/reports, whether follow-up tests were required and the outcome, any cardiac diagnosis, and any major adverse cardiac events.
The data collected will be re-identifiable. Once the information is entered into the Registry, it will be given a unique identification number which links to each athlete’s name and date of birth. This information allows ARENA to link multiple screenings to the same athlete, identify duplicates, add later outcome data (e.g. details of a cardiac diagnosis) or to communicate with the sporting organisation (e.g. if a previously unrecognised ECG abnormality is noticed by the Registry team or if the sport/athlete requests a copy of their own data).
Athletes can opt-out at any time if desired (see ‘Participant materials’ for more details).
- Participant Information Statement – Athletes (pdf, 181KB)
- Participant Information Statement – Sporting Organisations (pdf, 213KB)
AIS athletes and sporting organisations:
- AIS athlete flyer (pdf, 192KB)
- Participant Information Statement - AIS athletes (pdf, 183KB)
- Participant Information Statement - AIS sports (pdf, 216KB)
Athlete ECG criteria: 2025 update
IC25 expert panel in Seattle, September 2025
The 3rd International Summit on ECG Interpretation in Athletes was held in September 2025 in Seattle USA. The prior two ECG interpretation summits (2012 and 2015) were milestone achievements for the sports medicine and cardiology communities. The resulting recommendations published as the ‘Seattle Criteria’ and ‘International Criteria’ became the global standard for ECG interpretation in athletes, and the accompanying (free) ECG interpretation training modules remain essential training for sports medicine and cardiology physicians around the world.
The 2025 summit will update the criteria and recommendations for secondary testing of ECG abnormalities based on new and emerging science. These updates will be published in 2026. Recordings of the summit and other ECG resources are available for free from the IC25 website.