Abstract
Sudden cardiac arrest in athletes is a rare but dramatic event. The value of a routine electrocardiogram (ECG) during preparticipation screening (PPS) remains controversial, partly because of the relatively high number of false positive findings. Our study aimed to evaluate the prevalence of abnormal ECGs in consecutive Swiss elite athletes, overall and with regard to different sports classes, using modern screening criteria. We analysed the 12-lead resting ECGs of high-level elite athletes (age ≥14 years) recorded at the Swiss Olympic Medical Centre Magglingen between 2013 and 2016 during routine PPS. The overall prevalence of abnormal ECGs was evaluated and compared in accordance with the original and revised Seattle criteria. Sports disciplines were categorised according to their static (estimated percentage of maximal voluntary contraction, I-III) and dynamic (estimated percentage of maximal oxygen uptake, A-C) components, and the prevalence of abnormal ECGs compared between sports classes by Fisher's exact test (with alpha set at 0.05). ECGs from 287 consecutive athletes were analysed (64.1% male; 99.7% Caucasian; median age 20.4 ± 4.9 years; median weekly training volume 17.7 ± 7.1 hours). Based on original Seattle criteria, eight (2.8%) ECGs were classified as abnormal: three T-wave inversion (TWI), one Q-wave duration >40 ms, two QRS left axis deviation, two Q-wave amplitude >3 mm. The use of the revised Seattle criteria reduced the number of abnormal ECGs to four (1.4%): three TWI, one Q-wave duration >40 ms. Further cardiological work-up revealed an underlying structural heart disease in only one of these four athletes (inferolateral TWI on ECG), consisting of very localised mid-wall fibrosis suggestive of former myocarditis. There was a significant difference in occurrence of abnormal ECGs between the different sports categories (p = 0.018). All four abnormal ECGs according to the revised Seattle criteria occurred in the high dynamic sport classes (IIC and IIIC); three out of the four were found in the high dynamic high static class (IIIC). In our cohort of high-level elite athletes, the prevalence of abnormal ECGs according to modern screening criteria was very low. All athletes with an abnormal ECG performed high dynamic sports. Less than one percent of our athletes had a new relevant cardiac diagnosis.
Highlights
The cost-effectiveness of electrocardiogram (ECG) screening to prevent sudden cardiac arrest (SCA) in athletes is still intensely debated [1, 2], evidence supporting its accuracy for detecting athletes needing further cardiological work-up is growing
Our study aimed to evaluate the prevalence of abnormal ECGs in consecutive Swiss elite athletes, overall and with regard to different sports classes, using modern screening criteria
The aim of our study was to assess the prevalence of abnormal ECGs in the Swiss elite athlete population in accordance with the most recent ECG interpretation criteria, and to evaluate potential differences in the prevalence of ECG modifications according to sports discipline
Summary
The cost-effectiveness of electrocardiogram (ECG) screening to prevent sudden cardiac arrest (SCA) in athletes is still intensely debated [1, 2], evidence supporting its accuracy for detecting athletes needing further cardiological work-up is growing. Performance of a resting ECG during cardiovascular preparticipation screening (PPS) has been shown to be 5 times more sensitive than personal history and even 10 times more sensitive than physical examination alone to detect cardiovascular disease in athletes, together with a higher positive likelihood ratio [3]. The International Olympic Committee (IOC) and the European Society of Cardiology (ESC) recommend routine ECG screening of all competitive athletes [4, 5], the American Heart Association and the American College of Cardiology do not [6]. For Switzerland, the European PPS strategy has been adapted by the Swiss Society of Sports Medicine (SSSM) to include a specified medical history, a cardiac examination and a 12-lead resting ECG, recommended to start from the age of 14 years and to be repeated every 1 to 2 years until the end of the sports career [7]. A number of recommendations for ECG interpreta-
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