Black athlete electrocardiographic repolarization pattern

There is debate over the use of the electrocardiogram (ECG) to screen athletes for disorders associated with sudden cardiac death, but if screening is completed, accurate ECG interpretation is important. Recently, there has been recognition of a normal black athlete repolarization pattern which includes J-point elevation, convex ST-segment elevation, and T-wave inversions in leads V1 to V4 occurring in 5-15% of black athletes. This pattern must be differentiated from T-wave inversions that are associated with hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy. The combination of J-point elevation >1 mm and T-wave inversions confined to leads V1-V4 excludes cardiomyopathy. If T-wave inversions are present in the inferior or lateral leads or there is no J-point elevation, further evaluation for a cardiomyopathy is required. By recognizing this ECG pattern as a normal variant, unnecessary ancillary testing and restriction from sports can be avoided.