Although both U.S. and European guidelines recommend screening athletes for suspected heart disease before participation in competitive sport, they disagree on which findings are associated with increased risk as well as those athletes whose activities should be restricted. Recent Italian data suggest that screening programs can save lives, but few countries have fully adopted such practices. It is time to develop an international consensus on who should receive pre-participation screening, who should perform the screening, what tests the screening should consist of, and what criteria should be used to restrict participation.