Electrocardiogram In Athletes Research Articles

Outcomes of 10 years of cardiac screening of elite New Zealand athletes

Abstract Background/Introduction Cardiac screening of competitive athletes for conditions associated with sudden cardiac death is recommended by bodies including the European Society of Cardiology. High Performance Sport New Zealand (HPSNZ) commenced cardiac screening of elite Olympic sport athletes in 2012. Purpose To report the 10 year outcomes and findings of the HPSNZ cardiac screening program, including comparisons of electrocardiogram (ECG) features between sexes, sports and ethnicities. Methods Athletes were screened by HPSNZ from February 2012-June 2022 in accordance with HPSNZ protocols and as required by their International Federations. Screening included a personal/family history, physical examination and resting 12-lead ECG (interpreted by a cardiologist experienced in athlete ECGs), and athletes were followed for up to 11 years. Clinical findings and ECGs were managed contemporaneously as required. In July 2022 all screening records, including demographic data, ECGs, follow-up testing and diagnoses were reviewed. Although ECG guidelines changed during the period, any abnormal/equivocal ECGs were re-reviewed using the International Criteria. Comparisons between groups were performed using Fisher’s exact test (2-sided, p<0.05 considered significant). Results 2075 ECGs from 1189 athletes (53% female, mean age 21 years; 83% European, 14% Māori and Pacific Islander, 3% other ethnicities) were included. Major diagnoses included Wolff-Parkinson-White (WPW) syndrome (0.7%) and cardiomyopathies (0.3%). Overall, 3.5% of ECGs were abnormal (International Criteria). ECGs of female athletes were more frequently abnormal (4.4% vs 2.5%, p=0.02) and had more abnormal T-wave inversion (TWI) (3.1% vs 0.9%, p=0.0005) compared to males. 47% of the abnormal TWI in females was limited to V1-V3 with no other ECG abnormalities. There were no differences in the proportion of abnormal ECGs between the highest intensity/endurance sports and other sports, nor between Māori and Pacific Island athlete ECGs compared with European (Table 1). No athletes retired for cardiac reasons, there were no cardiac deaths nor major cardiac incidents during the period (mean follow up from first screening: 73 months). There was a significant reduction in follow-up tests recommended after the introduction of the International Criteria. Conclusions WPW was the most frequent diagnosis, with very little cardiomyopathy found in this cohort. The proportion of abnormal ECGs was low overall, and lowest after the introduction of the most recent athlete ECG guidelines, likely reflecting enhanced specificity. ECGs of female athletes were more frequently abnormal, predominantly because of anterior TWI V1-V3, which potentially could be considered a normal finding in elite female athletes. We report for the first time a comparison between Māori/Pacific Island athletes and European athletes, showing no difference in the proportion of abnormal ECGs, although further data are needed.

Природа общей мощности спектра и очень низкочастотных волн кардиоинтервалограммы с позиций адаптации организма человека к двигательной активности (обзор)

It is known that heart rate variability (HRV), evaluated using interval electrocardiography (ECG), reflects the influence of the autonomic nervous system (АNS) and biologically active substances on cardiac activity. For this reason, interval ECG method is widely used in sports, as it reveals the mechanisms of human adaptation to motor activity. This article analyses data on the median values of the total power (TP) of the HRV spectrum and absolute and relative power of very low frequency (VLF) waves on the interval electrocardiogram in athletes recorded in the supine position. We chose these three indicators out of more than 30 others due to their informativeness and due to the debatable issue of the nature of VLF waves. Literature data and unpublished results of our studies allow us to conclude that the values of these indicators in athletes depend on a number of factors, including type of sports (being especially high in sports building aerobic endurance), level of athletic skill (being maximum in elite athletes) as well as volume and intensity of training. In elite skiers, the values of these three indicators tend to change in the course of the training year, increasing in the preparatory phase, staying at a high level or even increasing during the competitive phase, and decreasing in the transition phase, which is determined by the relevant dynamics of the training volume throughout the year. The authors believe that the increase in the values of these three HRV indicators points to the growing influence of the parasympathetic division of ANS and non-neuronal acetylcholine on cardiac activity under heavy training volumes. According to the authors, the values of these three indicators reflect the level of aerobic motor activity (the higher they are, the higher this activity).

The athlete's ECG : What is normal or abnormal?

The electrocardiogram (ECG) has become amobile and cost-effective routine assessment tool to risk stratify leisure-time and professional athletes during preparticipation screening. A central goal is the reduction of sudden cardiac death in sports through early recognition of the most prevalent underlying cardiac pathologies, e.g., hereditary cardiomyopathies or primary arrhythmias. Continuous evolution of the first ECG criteria for athletes, presented in 2010 by the European Society of Cardiology (ESC), has helped to improve the specificity of the criteria to both detect cardiac pathologies in early stages and differentiate from physiologic adaptation of the athlete's heart. Thus, the risk of false-positive findings and erroneous stigmatizations of athletes has been successfully reduced. This review article intends to trace back the changes of the ECG criteria in the light of agrowing body of scientific evidence over the last 15years, to present the key messages of the current International ECG criteria from 2017 and to identify some of the remaining challenges that wait to be answered by physicians in the field of sports medicine and sports cardiology.

COMMUNITY-TO-INSTITUTION ATHLETIC CARDIOVASCULAR SCREENING: VALIDATION OF AN ELECTROCARDIOGRAM WORKFLOW MODEL

COMMUNITY-TO-INSTITUTION ATHLETIC CARDIOVASCULAR SCREENING: VALIDATION OF AN ELECTROCARDIOGRAM WORKFLOW MODEL

Analysis of athlete QT intervals by age: Fridericia and Hodges heart rate corrections outperform Bazett for athlete ECG screening

BackgroundCardiac screening of elite athletes including a 12‑lead electrocardiogram (ECG) is recommended by numerous international bodies. Current athlete ECG interpretation guidelines recommend the Bazett method to correct the QT interval (QTc). ObjectiveThis study sought to investigate normative QTc changes by age using athlete screening ECGs and different QT correction methods in a population of elite cricketers. MethodsInitial cardiac screening ECGs from an existing database of elite Australian cricketers aged 14–35 years were examined. Average QT interval, QTcB (corrected QT–Bazett), QTcF (Fridericia), QTcH (Hodges), and heart rate (HR) were analyzed by age and sex. ResultsA total of 1310 athletes (66% male, 34% female) were included with mean age 19.1 years and mean heart rate 66.9 bpm (range 38-121 bpm). With increasing age, HR decreased and absolute QT increased. The pattern of QTc change with age differed depending on the method of correction: Bazett correction (QTcB) demonstrated a “dish-shaped” or broad U-shaped appearance; while Fridericia and Hodges corrections showed a linear increase in QTc from young to older age. The Bazett method had a stronger correlation of HR with QTc (R2 = 0.32) than either Fridericia (R2 = 0.0007) or Hodges (R2 = 0.009) methods. ConclusionsThe Bazett method is not the most accurate QT correction in athletes, especially during adolescence. In elite cricketers, QTcB revealed a drop in QTc from adolescence to early adulthood due to mis-correction of the QT interval. The Fridericia method has the smoothest correction of HR and least QT variation by age and may be preferred for athlete screening.

Guide to the Female Student Athlete ECG: A Comprehensive Study of 3466 Young, Racially Diverse Athletes

ObjectivesThe 12-lead electrocardiogram (ECG) is used in the preparticipation screening examination for athletes. Despite known differences in ECG findings by sex, only QTc prolongation is given a sex-specific threshold. We hypothesize that our large dataset—with diversity in age, race, and sport participation—can be utilized to improve ECG screening in female student athletes. MethodsComputerized 12-lead ECGs were recorded and analyzed in female athletes who underwent preparticipation screening examination between June 2010 and September 2021. The quantitative, empirical 2017 international criteria for electrocardiographic interpretation were compared with either the 99th percentile in our cohort or the percentile that corresponded to the known disease prevalence. ResultsOf 3466 female athletes with ECGs as part of preparticipation screening examination, the 2017 international criteria classified 2.1% of athletes with at least one ECG abnormality requiring cardiological evaluation. Rates were similar across age, race/ethnicity, and sporting discipline. Using ranges based on our population, 2.7% of athletes would require additional workup. Surprisingly, ST depression up to 0.03 mV was a normal finding in this cohort. If RS voltage extremes were considered findings requiring follow-up, an additional 9.6% of the athlete population would be flagged using current definitions. This number decreases to 2.7% if using the 99th percentile in this cohort. ConclusionThese results highlight a difference in the reported prevalence of ECG abnormalities when comparing empirically derived thresholds to statistically derived ranges. Consideration of new metrics specific to the female athlete population has the potential to further refine athlete ECG screening.

Athlete ECG T-wave abnormality interpretation patterns by non-experts

BackgroundThe presence of T-wave abnormalities (TWA) on an athlete's electrocardiogram (ECG) presents as a diagnostic challenge for physicians. Types of TWA patterns classified as abnormal by inexperienced readers have not been systematically analyzed. MethodsECGs from the 2011–2015 National Football League Scouting Combine (initially interpreted by general cardiologists) were retrospectively reviewed by expert sports cardiologists with strict application of the 2017 International Criteria. Patterns of TWA that were altered from the original interpretation were analyzed. ResultsThe study included 1643 athletes (mean age 22 years). There was a 67 % reduction in the number of athletes with any TWA (p < 0.001) with 111 ECGs changed to normal. Inferior TWA was the most common interpreted initial ECG abnormality altered followed by anterior and lateral. DiscussionThis analysis revealed an initial high rate of TWA by non-expert readers. Tailored education programs to physicians who interpret athlete ECGs should highlight these specific T-wave patterns. We see this as an opportunity to make more clinicians aware of ECG interpretation guidelines as sports trained cardiologists are mostly self-taught.

Analysis of Athlete QT Intervals by Age: Fridericia and Hodges Heart Rate Corrections Outperform Bazett’s for Athlete ECG Screening

Cardiac screening of elite athletes including a 12-lead electrocardiogram (ECG) is recommended by international bodies. Current guidelines recommend use of Bazett’s correction for QT interval. Cricket Australia regularly screens elite players using these criteria.

Validation of a 6-lead smartphone ECG against 12-lead ECG in athletes

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JO is supported by an Australian Government Research Training Program scholarship. CS is the recipient of a National Health and Medical Research Council (NHMRC) Practitioner Fellowship (#1154992). Background Athletes sometimes experience transient arrhythmias during intense exercise, which may be difficult to capture with traditional monitors. New highly portable technology, such as smartphone electrocardiogram (ECG) devices, may be useful in documenting and diagnosing exercise-induced arrhythmias. Accuracy of the Kardia single-lead ECG (1L) has been documented, but little data exists for the 6-lead device (6L). Purpose To examine the level of similarity between resting 6L and 12L readings to build evidence for the utility of the 6L as a practical diagnostic tool in athletes. Methods Participants (n = 30 healthy athletes, mean age 18.9 years, 57% male) had a resting supine 12-lead ECG (12L) as part of cardiac screening required by their sport. Within 1 hour, a 30 second 6L reading (leads I, II, III, aVR, aVL, aVF) was taken whilst seated. Data were analysed by 4 expert cardiologists. Manual measurements were taken for PR, QT and RR intervals and QRS duration using EPS digital calipers. To calculate mean 6L RR interval and QT prior to QTc, &amp;lt;10 sequential RR/QT measurements were taken from the middle 10 seconds. QTc was calculated using Bazett’s formula. ECGs were reviewed for rhythm and presence of atrial/ventricular ectopics. Continuous variables were expressed as the mean of 4 cardiologists’ values ± standard deviation. Two-tailed paired t-tests were used to compare continuous variables (p &amp;lt; 0.05 significant). Bland-Altman plots were used to assess quantitative agreement between QRS axis and mean values for QTc interval, QRS duration and PR interval for paired 6L and 12L ECGs. Results There were relatively high levels of agreement between the mean 6L and 12L measures for QTc and PR interval and QRS duration, with the 6L readings slightly but significantly shorter on average. The largest difference was seen in the QTc intervals (391ms vs 401ms, p = 0.003). The 6L QRS durations were shorter on average by 3ms (89ms vs 92ms, p = 0.025) and PR intervals were shorter on average by 6ms (163ms vs 169ms, p &amp;lt; 0.001). There was complete agreement for all cardiologists for sinus rhythm and the presence of ectopics for the 6L and 12L readings. Conclusions The 6L readings had relatively high agreement with the 12L. All 6L measures (except heart rate) were slightly shorter on average than 12L. These small differences are unlikely to have any clinical significance, and are similar to findings comparing the 1L to 12L. 6L heart rates were slightly higher, which is best explained by seated compared to lying position. The reading with the greatest variation was QT interval, some of which is explained by heart rate variation. These pilot data suggest the 6L is sufficiently accurate to be useful in an athletic population as an event monitor for exercise-induced arrhythmias. This may provide more useful diagnostic data than the 1L. Larger studies showing higher levels of agreement with 12L would be required to expand the role of 6L beyond an event monitor. Abstract Figure 1: 6L device, Bland-Altman plots

Comparison between a 6‑lead smartphone ECG and 12‑lead ECG in athletes

Athletes sometimes experience transient arrhythmias during intense exercise, which may be difficult to capture with traditional Holter monitors. New and highly portable technology, such as smartphone electrocardiogram (ECG) devices, may be useful in documenting and contribute to diagnosis of exercise-induced arrhythmias. There are little data available regarding the new Kardia 6 lead device (6L) and no data regarding its use in athletic populations. In this short communication, we present pilot data from 30 healthy athletes who underwent a 12‑lead ECG and subsequent 6L reading. Our pilot data show relatively high levels of agreement for QTc and PR interval and QRS duration, with the 6L readings slightly but significantly shorter on average.

Evaluating the 12-Lead Electrocardiogram for Diagnosing ARVC in Young Populations: Implications for Preparticipation Screening of Athletes

BackgroundArrhythmogenic right-ventricular cardiomyopathy (ARVC) is an identified cause of sport-related sudden cardiac arrest (SCA). Identifying athletes with ARVC and restricting them from exercise is believed to reduce the risk of SCA. The electrocardiogram (ECG) is considered to be an important component of screening for ARVC; however, the sensitivity of the 12-lead ECG to identify ARVC in young asymptomatic persons is unknown. MethodsIn this retrospective study, we identified 70 patients (49 ARVC-positive, based on Task Force Criteria, and 21 age-matched ARVC-negative persons from a paediatric arrhythmia database (<18 years of age); ECGs were analyzed for abnormalities, based on International Criteria for Interpretation of ECGs in Athletes, and ECG findings were adjudicated by group consensus. ResultsOf the 49 ARVC-positive patients (median age: 17 [interquartile range: 16-18], 65% male), 22% were found to have abnormal ECGs; the most common ECG findings were T-wave inversions. Patients with symptoms were more likely to have abnormal ECGs than asymptomatic patients (28% compared with 17%, respectively; P = 0.002). Of 16 gene-positive patients, 31% had abnormal ECGs. Patients with abnormal ECGs had larger right-ventricular end-diastolic volume indexes on magnetic resonance imaging than those with normal ECGs (P = 0.03). ConclusionsThe ECG was insensitive for detecting ARVC in young (age <18 years), asymptomatic patients, and is unlikely to provide significant diagnostic value for identifying ARVC on routine preparticipation screening of adolescent athletes.

You've got to be in it to win it: the importance of including female athletes in screening ECG cohorts

Abstract Background ECG screening is widely employed in athletic populations with the aim of identifying cardiac conditions associated with sudden death. Recommendations for athlete ECG interpretation are disproportionately reliant on data from male athletes and sex-specific differences have not been adequately elucidated. Purpose The aim of this study is to identify any different patterns in female athletic training response on ECG screening. Methods 444 elite athletes (156 male rowers, 135 female rowers, 117 male cricketers, 36 female cricketers) underwent electrocardiogram (ECG) screening. Standard definitions were used to characterize abnormalities identified on ECG. Comparisons were made according to sex and endurance (rowing) vs skill-based (cricket) athletes (EA and SBA respectively). Results “Potentially pathological” T-wave inversion extending to V3 was more prevalent in female athletes (9.9% vs. 2.9%, P=0.002), especially amongst endurance athletes (11.9% female EA vs. 2.8% female SBA, P=0.004) (Figure 1). As compared with males, the QTc interval was longer in female athletes (418 vs. 402ms), the QRS duration was shorter (90 vs. 100 ms) and left ventricular hypertrophy on voltage criteria were less prevalent (9.9% vs. 33.3%, P&amp;lt;0.001 for all). First-degree heart block and incomplete right bundle branch block were more prevalent amongst male athletes. Conclusion Female athletes exhibit different training-related cardiac remodelling responses to exercise compared to males. A greater proportion of ostensibly healthy female athletes, especially female endurance athletes, have ECG changes that would be deemed “potentially pathological” according to current sex-agnostic guidelines. Figure 1 Funding Acknowledgement Type of funding source: None

Criteria for interpretation of the athlete's ECG: A critical appraisal.

The electrocardiogram (ECG) is cheap and widely available but its use as a screening tool for early identification of athletes with a cardiac disease at risk of sudden cardiac death is controversial because of presumed low specificity. In the last decade, several efforts have been made to improve the distinction between physiological and pathological ECG findings in the athlete, leading to continuous evolution of the interpretation criteria. The most recent 2017 International criteria grouped ECG changes into three categories: normal, borderline, and abnormal. Borderline findings warrant further investigations only when two or more are present while abnormal changes should always be considered as the sign of a possible underlying disease. This review encompasses the evolution of the athlete's ECG interpretation criteria and highlights areas of uncertainty that will need to be addressed by further studies.

Physiological or pathological hypertrophy of athlete’s heart syndrome

Intense physical activity increases the risk of sudden death by 10–17 fold. Some of the most important tasks of modern pathophysiology in sports medicine include searching for factors that allow an athlete’s body to adapt to loads, understanding the line between adaptation and pathology and identifying risk groups of adaptation failure. It is necessary to distinguish between hypertrophic cardiomyopathy and true myocardial hypertrophy in athletes that results from the adaptation of the cardiovascular system to intense physical exertion. In Seattle, the American Medical Society of Sports Medicine together with the European Society of Cardiology proposed standards for the interpretation of electrocardiogram in athletes and considered criteria for the detection of pathological changes. The best functional state of an athlete and the effectiveness of his/her training are noted with high autonomy and high variability of heart rate. This is reflected in rhythmocardiogram data by increases in high frequency and root mean square of successive differences in heartbeats and a decrease in the low-frequency to high-frequency ratio.A promising direction in the study of markers of an athletic heart is the analysis of echocardiographic (EchoCG) images of young and professional athletes. According to EchoСG analysis, nonadaptive remodelling is the loss of the ellipsoid shape of the left ventricle in favour of a spherical one. In athletes, when assessing transmitral flow by EchoCG, a low A peak can be considered a reserve of adaptive capabilities of the heart and not a pathology. For athletes-dischargers, a concentric variant of changing the geometry of the myocardium is characteristic. Upon reaching the qualification of a candidate, master of sportsan eccentric change in the left ventricle cavity prevails.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributionsConception and design: Y.P. Skirdenko Drafting the article: A.V. Gorbenko, O.V. Zamahina, S.A. SherstyukCritical revision of the article: N.A. NikolaevFinal approval of the version to be published: A.V. Gorbenko, Y.P. Skirdenko, N.A. Nikolaev, O.V. Zamahina, S.A. Sherstyuk, A.V. Ershov

EFFECT OF POSTULAR BALANCE ON CHANGE IN HEART RHYTHM AND CONDUCTIVITY IN SWIMMERS

Aim. The purpose of the study is to predict the occurrence or reveal changes in the electrocardiogram (ECG) of swimmers with the help of stabilometric indicators. Materials and methods. Sixty qualified athletes participated in the study (CMS, MS, age 16–18 years). Bicycle ergometry was used to detect cardiac rhythm and conduction abnormalities, and a stabilometric complex was used to assess postural balance. Results. Incomplete right bundle branch block (RBBB) was observed in 53.33% of athletes; first-degree sinoatrial (SA) block – in 10.01%; extrasystoles (supraventricular: atrial, atrioventricular) – in 33.33%; pacemaker migrations – in 3.33%. Athletes in group 0 recorded a higher level of fluctuations in the center of pressure in the frontal plane in all tests (p ≤ 0.05): COP-RMSD in FP MS EO (&gt; 132.32%), LHT (&gt; 31.94%), RHT (&gt; 76.82%), MS EC (&gt; 83.56%), LHT EC (&gt; 68.61%), RHT EC (&gt; by 87.65%). Using Random Forest machine learning algorithm, it is possible to predict the occurrence or detect changes in the heart rhythm and conductivity in swimmers. Conclusion. The features of changes in the electrocardiogram of athletes were considered, the compared parameters of stabilometry data with and without ECG changes were significant at p &lt; 0.05. A Random Forest model was created to predict or detect changes in the ECG of athletes with the help of stabilometric indicators.

Cardiovascular Screening of Elite Athletes by Sporting Organizations in Australia: A Survey of Chief Medical Officers.

To compare cardiovascular screening policies of Australian elite sporting organizations. Online survey. Elite/professional sports in Australia. Chief medical officers (CMOs) of elite/professional sports in Australia, including rugby union and league, cricket, tennis, Australian football, and cycling. Survey questions about each sport's cardiac screening policy: which screening components were included [eg, history and physical (H&P), resting 12-lead electrocardiogram (ECG)], whether screening was mandatory, whether the policy applied to elite junior and/or adult players, and which criteria were used to interpret ECGs. Which sports had a formal cardiac screening policy, which athletes the policy applied to, components of screening, ECG interpretation criteria used. Chief medical officers for 22/31 (71%) sports responded, representing >5000 athletes. Of these, 19/22 (86%) perform regular screening (100% H&P; 89% included ECG) with international cyclists also having routine echocardiograms and stress testing. Thirty-three percent of CMOs used the 2017 International Criteria for athlete ECG interpretation. Screening was mandatory with enforcement (26%), mandatory without enforcement (48%), and opt-out (26%). All screened adult elite athletes, and 68% screened junior elite athletes. Forty-two percent indicated athletes were required to pay for screening tests, and 63% required athletes to pay for follow-up tests. Almost all (94%) sports with a sports physician as the CMO screened athletes. Most sports have a screening policy, with reasonable uniformity of components. All included H&P, and almost all included ECG. Only one sport included an echocardiogram and stress test as a standard (international players only). Promoting the latest ECG interpretation criteria may reduce false-positives and cost. Future work should explore cardiac emergency plans, screening infrastructure, cost, and long-term follow-up.

697 ECG Features of Male and Female Elite Indigenous Australian Cricketers

Many sports, including Australian cricket, now conduct pre-participation cardiac screening of elite athletes, including a 12-lead electrocardiogram (ECG). Current athlete ECG interpretation criteria have substantially improved sensitivity and specificity, but differences in sex and ethnicity (other than Black African-American) are not discussed. To compare ECG features of elite male and female Australian indigenous cricketers to non-indigenous cricketers. Players were screened in accordance with Cricket Australia policy. Screening records were extracted from a complete online database were examined for all elite indigenous players (November 2014-March 2020, n=37) and non-indigenous players (as at 1 February 2019, n=688), male and female, aged ≥16 years. Indigenous status was determined according to self-report. ECGs were reviewed by sports cardiologists according to the International criteria, and comparisons were made according to sex and indigenous status. Review of ECGs from 42 (38% female) indigenous players and 808 (37% female) non-indigenous players showed that indigenous male cricketers had significantly more anterior T-wave inversion (V1-V2) (3.8% vs 0.0%, p<0.05) and significantly shorter mean QTc interval compared to non-indigenous males (391ms vs 402ms, p=0.03). No major differences were seen between indigenous and non-indigenous female cricketers. Data from a small cohort of indigenous male and female elite cricketers show some differences in ECG features compared to non-indigenous players. These preliminary findings may have important implications for ECG screening in indigenous athletes. If supported by larger studies, additional considerations based on ethnicity and gender may need to be reflected in guidelines for athlete ECG interpretation.

Регистрация электрокардиограммы спортсмена — практические аспекты

Регистрация электрокардиограммы спортсмена — практические аспекты

Sportsko srce - savremeni dijagnostički pristup

The athlete's heart is an exercise-induced cardiac remodeling phenomenon, which is individual and depends on the intensity, duration and frequency of training, as well as genetic factors. Cardiovascular screening prior to participation in sports activities, is a systematic practice of medical evaluation in the athlete population. The current US recommendations for the screening of cardiovascular abnormalities in high school and university athletes at all levels of performance were initially put forther by the American Heart Association in 2007. These recommendations consist of 12 points, factoring personal and family history data, as well as physical examination. On the other hand, European recommendations suggest the importance of non-invasive diagnostic methods, such as the 12-lead ECG, which should be carried out in combination with a history and physical examination. According to the European Association for Cardiovascular Imaging, standard echocardiography is the first line approach to differentiate an athlete's heart from pathological left ventricular hypertrophy. Updated 'Seattle criteria' from 2017. include criteria for assessing abnormalities in the electrocardiogram of athletes and their differentiation from the adaptive electrophysiological changes, which do not require further evaluation. Since sudden cardiac death during sport activities remains a major concern and, as such, it is imperative for the physician to diagnose unrecognized pathological conditions in athletes. Following current expert consensus recommendations on this topic helps to prevent untoward events during physical activity in those who are found to be at elevated risk.

Variabilidade na interpretação do eletrocardiograma do atleta: mais uma limitação na avaliação pré‐competitiva

IntroductionAssessment of the electrocardiogram (ECG) in athletes remains controversial, with lack of standardization and difficulty in applying specific criteria in its interpretation. The purpose of this study was to assess variability in the interpretation of the ECG in athletes. MethodsTwenty ECGs of competitive athletes were assessed by cardiologists and cardiology residents, 11 of them normal or with isolated physiological changes and nine pathological. Each ECG was classified as normal/physiological or pathological, with or without the use of specific interpretation criteria. ResultsThe study presents responses from 58 physicians, 42 (72.4%) of them cardiologists. Sixteen (27.6%) physicians reported that they regularly assessed athletes and 32 (55.2%) did not use specific ECG interpretation criteria, of which the Seattle criteria were the most commonly used (n=13). Each physician interpreted 15±2 ECGs correctly, corresponding to 74% of the total number of ECGs (variation: 45%‐100%). Interpretation of pathological ECGs was correct in 68% (variation: 22%‐100%) and of normal/physiological in 79% (variation: 55%‐100%). There was no significant difference in interpretation between cardiologists and residents (74±10% vs. 75±10%; p=0.724) or between those who regularly assessed athletes and those who did not (77±12% vs. 73±9%; p=0.286), but there was a trend for a higher rate of correct interpretation using specific criteria (77±10% vs. 72±10%; p=0.092). The reproducibility of the study was excellent (intraclass correlation coefficient=0.972; p<0.001). ConclusionsA quarter of the ECGs were not correctly assessed and variability in interpretation was high. The use of specific criteria can improve the accuracy of interpretation of athletes’ ECGs, which is an important part of pre‐competitive screening, but one that is underused.