Young athletes' ECG: Incomplete right bundle branch block vs crista supraventricularis pattern
Leonel Diaz-Gonzalez1, Vanesa Bruña2, Jesús Velásquez-Rodriguez3
1Cardiology Department of CEMTRO Clinic, Madrid, Spain.
Insights
Crista supraventricularis pattern (CSP) is common in young athletes, potentially misdiagnosed as incomplete right bundle branch block (IRBBB). Differentiating CSP from IRBBB can improve athlete ECG interpretation during pre-participation screening.
Area of Science:
- Pediatric Cardiology
- Sports Medicine
- Electrocardiography
Background:
- Incomplete right bundle branch block (IRBBB) is common in athletes, but its cause is not fully understood.
- The crista supraventricularis pattern (CSP) resembles IRBBB but has different underlying mechanisms and has not been studied in athletes.
- Distinguishing CSP from IRBBB is crucial for accurate pre-participation screening (PPS) in athletes, as IRBBB can be linked to serious cardiac conditions.
Purpose of the Study:
- To determine the prevalence of the crista supraventricularis pattern (CSP) in young athletes.
- To assess the potential for misdiagnosis of CSP as IRBBB in sports pre-participation screening.
- To provide data that can enhance the interpretation of ECGs in young athletes.
Main Methods:
- An observational study analyzed standard 12-lead resting ECGs.
- The study included children aged 5-16 years undergoing pre-participation screening.
- Data were collected between August 2018 and May 2019.
Main Results:
- The study analyzed 6,401 children, predominantly male soccer players.
- The prevalence of CSP was 13.3% (850 participants), while IRBBB was found in 8.6% (553 participants).
- Athletes with CSP showed a higher proportion of the S1S2S3 pattern compared to other QRS morphologies.
Conclusions:
- Crista supraventricularis pattern (CSP) may be frequently overlooked or misdiagnosed as IRBBB in pediatric sports pre-participation screening.
- The higher prevalence of CSP suggests it is a common finding in young athletes.
- Accurate differentiation between CSP and IRBBB can improve ECG interpretation and the diagnostic value of pre-participation screening for young athletes.
Background:
Incomplete right bundle branch block (IRBBB) is prevalent among athletes, but its etiology remains to be clearly elucidated and the commonly advocated mechanism, an intraventricular conduction delay, does not explain all cases. In the general population, an apparently similar phenomenon but with different pathophysiology and potential consequences, "crista supraventricularis pattern" (CSP, defined as QRS ≤ 100 ms, S wave <40 ms in I or V6 together with an RSR´ pattern in lead-V1) has been described. Yet, this manifestation has not been studied in athletes. Given that IRBBB can be associated with some serious conditions (including Brugada syndrome, arrhythmogenic cardiomyopathy, or atrial septal defects) the differentiation between IRBB and CSP could enhance the accuracy of the pre-participation screening (PPS). We thus aimed to determine the prevalence of CSP in young athletes.
Methods:
Observational study of standard 12-lead resting ECG in a cohort of children (5-16 years) attending a PPS program (August 2018-May 2019).
Results:
6,401 children (mean ± SD age 11.2 ± 2.9 years, 99.2% Caucasian, 93.8% male, 97.2% soccer players) were studied. We found CSP in 850 participants (prevalence = 13.3% [95% confidence interval 12.5-14.1]) whereas 553 (8.6%) had IRBBB. The proportion of athletes showing an S1S2S3 pattern was higher in those with CSP compared with the other QRS morphologies (P < .05).
Conclusions:
CSP might have been overlooked in previous reports of sports PPS for children and misdiagnosed as IRBBB, as the proportion of the former condition was higher. Our findings might add useful information to improve the interpretation of the young athletes' ECG and thus the diagnostic value of PPS.
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