Since 1971, in Italy every citizen engaged in competitive sports activity must periodically undergo preventive medical examinations to ascertain eligibility for sports participation. The medical examination includes rest and effort ECG. The Italian model has a very good sensitivity in identifying most pathologies at risk of sudden death particularly in the young (hypertrophic cadiomyopathy, arrhythmogenic right ventricular disease, chanelopathies). In this model, the ECG is very important, being able to disclose cardiac anomalies in most cases. The application of the Italian screening model has progressively reduced the incidence of sudden death in athletes.