Are the QRS duration and ST depression cut-points from the Seattle criteria too conservative?

Abstract

BackgroundScreening athletes with ECGs is aimed at identifying "at-risk" individuals who may have a cardiac condition predisposing them to sudden cardiac death. The Seattle criteria highlight QRS duration greater than 140ms and ST segment depression in two or more leads greater than 50μV as two abnormal ECG patterns associated with sudden cardiac death. MethodsHigh school, college, and professional athletes underwent 12 lead ECGs as part of routine pre-participation physicals. Prevalence of prolonged QRS duration was measured using cut-points of 120, 125, 130, and 140ms. ST segment depression was measured in all leads except leads III, aVR, and V1 with cut-points of 25μV and 50μV. ResultsBetween June 2010 and November 2013, 1595 participants including 297 (167 male, mean age 16.2) high school athletes, 1016 (541 male, mean age 18.8) college athletes, and 282 (mean age 26.6) male professional athletes underwent screening with an ECG. Only 3 athletes (0.2%) had a QRS duration greater than 125ms. ST segment depression in two or more leads greater than 50μV was uncommon (0.8%), while the prevalence of ST segment depression in two or more leads increased to 4.5% with a cut-point of 25μV. ConclusionChanging the QRS duration cut-point to 125ms would increase the sensitivity of the screening ECG, without a significant increase in false-positives. However, changing the ST segment depression cut-point to 25μV would lead to a significant increase in false-positives and would therefore not be justified.