Electrocardiographic changes after completion of a triathlon

Abstract

ABSTRACT Objectives Given the increasing popularity of long-distance triathlon events amongst amateur athlete and the difficulty for emergency physician to address cardiovascular complaints in the context of exercise, this study aims to: -Identify the prevalence of electrocardiographic abnormalities before and after a long distance triathlon in a cohort of participants using the Seattle criteria. -Identify the acute changes that occur on their ECGs at the finish line of a long-distance triathlon. Methods This prospective observational study examines the prevalence of selected standard 12-lead ECG findings, the Seattle criteria, in asymptomatic athletes before and after the completion of a long-distance triathlon. Results Of 99 ECGs obtained prior to the race, 28 were abnormal, for a pre-race prevalence of 28.3% (95% CI (20.4, 37.8)). Of the 72 ECGs post-race, 12 were abnormal, for a post-race prevalence of 16.7% (95% CI (9.8, 26.9)). We did not observe any athletes with marked repolarization abnormalities. Common findings were increased QRS voltage significant for left ventricular hypertrophy (LVH) (24 (24.2%) pre-race, 10 (14.1%) post-race), early repolarization (21 (21.2%) pre-race, 19 (26.8%) post-race) and incomplete right bundle branch block (RBBB) (8 (8.1%) pre-race, 11 (15.5%) post-race). McNemar’s test showed no agreement between the ECG pre and post results (Chi-square =6.54, p = 0.01), suggesting a possible effect of the race on ECG findings. We observed a trend to normalization of athlete’s ECGs with acute exercise. Conclusion Long-distance endurance exercise might acutely affect the ECGs findings in asymptomatic athletes and abnormal ECG findings were common in our cohort of athletes. Physicians providing care to long-distance athletes should interpret ECGs in this population prudently. SUMMARY BOX The acute effect of exercises on athlete’s electrocardiograms has not been well studied. In our cohort of long-distance triathlon finishers, 28.3% of athletes had abnormal ECGs pre-race and 16.7% had abnormal ECGs post-race according to the Seattle Criteria. We observed a trend toward normalization of athlete’s ECGs with acute exercise. Common ECGs abnormalities found in those asymptomatic athletes were left ventricular hypertrophy, early repolarization and right bundle branch block. Physicians involved in the care of athletes should be prudent when interpreting ECGs in this population.