Young athletes' ECG: Incomplete right bundle branch block vs crista supraventricularis pattern

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.