A wide spectrum of diseases or conditions (genetically based or acquired), in the presence of triggering elements, can lead to arrhythmic events, having sudden death as a common result. The substrate of fatal arrhythmia depends on age: over 35 years old it is mainly represented by the instability of coronary heart disease. Up to 35 years of age, the substrate consists mainly of electrical or structural alterations of the heart of a genetic nature the main of which are i) idiopathic hypertrophic cardiomyopathy ii) arrhythmogenic cardiomyopathy of the right ventricle iii) congenital syndrome of long QT iv) congenital syndrome of short QT; v) Brugada syndrome. Each of these proarrhythmic genetic conditions has the prerogative of being able to be highlighted by an electrocardiogram: a simple and economical gesture that can lead directly to an important diagnosis, or at least make it suspected, addressing the subsequent evaluations. Formulating a diagnosis of this kind can minimize the risk of sudden death, through careful use of lifestyle advice, drugs, devices, procedures. It has been scientifically proved that identifying genetic conditions at risk of malignant arrhythmias in the athlete leads to a dramatic reduction in the risk of sudden death: on this basis, an electrocardiographic screening has become peremptory in many countries in order to be able to perform competitive sports (in Italy, for some years, also to be able to carry out non-competitive sports). Electrocardiographic screening should be considered for the entire youth population, regardless of participation in an organized sports activity program, as this can potentially mean saving young lives from sudden death
