Incidence of sudden cardiac death (SCD) in athletes under 35 years of age is between 0.4 and 4.4 in 100,000. The highest mortality is seen in older athletes (≥35 years) who engage in running, mostly because of complications of atherosclerotic coronary ischemic disease. Majority of European countries are guided by European Society of Cardiology’s (ESC) pre-participation screening (PPS) recommendations that include electrocardiography (ECG), while in the United States of America the ECG is not a routine part of the PPS examination. In Serbia, the ESC guidelines are being used, but there are no references prescribed by the Ministry of Health. The authors of this study believe that the national strategy for sport improvement should be accompanied with clear and well defined PPS recommendations that could be tenable in our health system.