The differences in electrocardiogram interpretation in top-level athletes

Area of Science:

• Sports Cardiology
• Cardiovascular Screening
• Exercise Physiology

Background:

• The Polish Ministry of Health recommends electrocardiogram (ECG) for athlete cardiovascular screening.
• Guidelines for preparticipation assessment in athletes are lacking.
• This study compares ECG screening criteria in elite athletes.

Purpose of the Study:

• Evaluate ECG changes requiring further work-up in athletes across age groups using three criteria.
• Identify factors influencing training-related and unrelated ECG changes.

Main Methods:

• 262 Polish athletes (rowers, cyclists, canoeists) aged 15-34 were studied.
• Athletes were divided into young (≤18) and elite (>18) age categories.
• ECGs were assessed using 2010 ESC, 2012 Seattle, and 2014 Refined criteria.

Main Results:

• Refined criteria reduced training-unrelated ECG findings to 8.0% (vs. 12.6% Seattle, 30.5% ESC).
• Older athletes showed more training-related changes (76.5% vs. 55.9%).
• Age, training duration, and male gender predicted adaptive ECG changes.

Conclusions:

• ESC criteria identified an unacceptably large group needing further tests.
• Refined criteria significantly decrease the need for additional cardiac investigations.
• Adaptive ECG changes are benign, linked to training duration and athlete age.