The ARENA project is a long-term international data repository which aims to improve our understanding of ECG interpretation cardiac diagnoses, and the rates of major cardiovascular outcomes in screened athletes.
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.
ARENA is endorsed by the Australasian College of Sport & Exercise Physicians and Sports Medicine Australia.
Full details are available in the ARENA project protocol, published in the Journal of the American Heart Association (2024).
The ARENA project is funded by an Australian Government National Health and Medical Research Council (NHMRC) Investigator Grant. The ARENA project has ethics approval from The University of Sydney Human Research Ethics Committee (Project No. 2023/551) and the Australian Institute of Sport (AIS) Ethics Committee (approval number 20240601).
The ARENA project is a declared federal quality assurance activity under part VC of the Health Insurance Act 1973 (Cth). This legislative protection is known as “qualified privilege” and aims to encourage clinicians and organisations to participate in quality improvement activities. It:
Written consent is provided by sporting organisations. No written consent is required from individual athletes.
Data is collected from most sporting organisations as follows:
Athletes are able 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).
AIS athletes and sporting organisations:
2025 updates to International Criteria for Athlete ECG Interpretation
The International Criteria for Athlete ECG Interpretation (2017) are the current gold standard for athlete ECG interpretation. The International Criteria are the most accurate athlete-specific criteria to date, with a sensitivity of 86% and an improved specificity (97-99%). While this reduction in the false positive rate has been helpful, a number of common interpretation challenges and potential future directions have been suggested based on evolving science.
Accordingly, the International Criteria are in the process of being updated. The 3rd International Summit on ECG Interpretation in Athletes was held in Seattle, USA in 2025. The new criteria are expected to be published in 2026.
