Abstract Introduction Sudden death among young (<35 years) athletes gets a lot of public attention and is often of cardiac origin. Athletes are at an increased risk of sudden cardiac death (SDC) and the main causes are heredetary. Most of the causative conditions can be detected by common diagnostic tools, screening therefore might seem appropriate. Screening programs are in use in selected populations, but is not common practice in Norway. Mainly because of worries of low efficacy, high cost/benefit ratio and traditionally a low specifisity of the screening methods. We sought to investigate wether or not pre-participation screening should be implemented for young athletes in Norway. Methods We did a systematic search in EMBASE and PubMed using keywords related to ”screening”, ”athlete” and ”sudden cardiac death”. We ended the search 12.12.18. We also included guidelines from The European Heart Association, The American Heart Association and international sports affiliations. In addition we reviewed the reference lists of the included papers for additional relevant resources. Results The reported incidens of SDC among young athletes range from 1:3000 to almost 1:1000 000 per year, but is generally accepted to be around 1:50 000. There are few studies that include sudden cardiac arrests (SCA). The leading cardiac causes include diseases of the myocardium, cardiac channelopathies, myocarditis and trauma to the chest (commotio cordis). New ECG guidelines have improved ECG specificity to 97%, lowering the need for secondary assesments (and costs). The estimated cost per life saved differs widely between papers, but probably exceeds the “payment-threshold” for most governments at the moment. The ability of screening programs to save lives is disputed and studies show different results regarding this matter. A newly published study screening over 11 000 athletes showed a false negative rate of 75% and no apparent reduction in incidence of SCD. Conclusions Heart screening of young athletes has yet to be proven cost effective and efficient in reducing sudden carciac arrests. The most appropriate screening alternative seems to include history, physical examination and ECG. A mandatory registry of SCD and SCA is needed, and there is a need for more studies on the efficacy on heart screening in young athletes. Untill proof is established, the focus should be kept on CPR-training and the availability of AEDs.