ReviewInterpretation of the Electrocardiogram in Athletes
Section snippets
Bradyarrhythmia
Sinus bradycardia is seen in up to 80% of athletes,1, 2, 3 however, a heart rate < 35 beats per minute (bpm) is rare and tends to only occur in endurance athletes.4 Sinus arrhythmia is noted in approximately 70% of athletes and first-degree atrioventricular (AV) heart block is present in 5%-13% of athletes.1, 3, 5 Mobitz type 1, junctional rhythm, and sinus pauses are also common (31%, 20%, and 37%, respectively)6 but predominantly at night. With increased sympathetic tone during exercise,
Endurance athletes
Endurance athletes such as those who compete in long-distance running, cycling, swimming, rowing, or canoeing show the highest prevalence of bradyarrhythmia, repolarization changes, and voltage criteria for ventricular hypertrophy. The prevalence of ECG changes is similar in men and women other than a lower prevalence of voltage criteria for LVH and ERPs in women.19
Although TWI in the chest leads (with the exception of V1-V2) is considered abnormal, there are data to suggest that up to 14% of
European Society of Cardiology recommendations
In 2010, the European Society of Cardiology (ESC) published a pragmatic approach to the interpretation of the young athlete's ECG30 on the basis of the findings from an Italian study of 32,652 athletes (mean age, 22.3 years old).31 ECG changes were categorized into benign training-related changes (class 1), or nontraining (possibly pathological) ECG patterns (class 2). The latter were present in < 5% of athletes whereas group 1 changes were detected in up to 80% of athletes (Fig. 5).
Group 1
Abnormal ECG Patterns
Although there is an overlap between some ECG patterns observed in athletes and individuals with cardiomyopathy, certain ECG patterns are definitely regarded as abnormal irrespective of the demographic characteristics or symptomatic status of the athlete (Fig. 8). These include ST segment depression and left bundle branch block. Whereas partial right bundle branch block (RBBB) is regarded as a normal variant, the situation with complete RBBB is less clear. RBBB is considered pathological
Conclusions
The ECG of the athlete usually exhibits changes because of their increased vagal tone and large cardiac dimensions. Certain manifestations of the athlete's ECG might overlap with those observed in cardiac diseases implicated in sudden cardiac death in athletes. An understanding of the physiological spectrum of ECG changes in athletes in relation to age, sex, ethnicity, and type of sport helps reduce the number of false positive results during preparticipation screening of asymptomatic athletes.
Acknowledgements
The authors thank Dr Velislav Batchvarov for assistance in obtaining ECGs.
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Cited by (12)
Use of the electrocardiogram in pre‐participation screening of athletes: For or against?
2017, Revista Portuguesa de CardiologiaThe Safety of Exercise in Individuals With Cardiomyopathy
2016, Canadian Journal of CardiologyCitation Excerpt :Most professional sporting organizations in Europe and North America conduct ECG screening in elite athletes. Various criteria and consensus documents are available to aid the interpretation of the athlete's electrocardiogram and have been described comprehensively in another article in this issue.6,12,26,27 Specific repolarization patterns, particularly T-wave inversion, are common in patients with cardiomyopathy but are also present in up to 3% of white athletes and 25% of black athletes.24
Body Surface Potential Mapping during Ventricular Depolarization in Athletes with Prolonged PQ Interval after Exercise
2024, Arquivos Brasileiros de CardiologiaLeft cardiac remodelling assessed by echocardiography is associated with rho-kinase activation in long-distance runners
2021, Journal of Cardiovascular Development and DiseaseYoung athletes' ECG: Incomplete right bundle branch block vs crista supraventricularis pattern
2020, Scandinavian Journal of Medicine and Science in Sports
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