Distinct early repolarisation patterns in male Brazilian soccer players: insights from a multicentre study

Early repolarisation (ER) is commonly observed during cardiovascular screenings of young athletes and can present with various morphologies. However, its prevalence and clinical significance in male Brazilian soccer players have not been characterised. This study aimed to compare the prevalence of different ER patterns and assess their potential clinical significance in this population.

In this multicentre observational study, we analysed ECG data from male Brazilian soccer players who underwent preparticipation evaluations at 83 professional clubs across Brazil's five geographic regions between February 2002 and August 2024. Our analysis included white, mixed-race and black athletes, as well as seven distinct ER morphologies. Poisson regression with robust variance was used to derive age-adjusted prevalence ratios for the different ER morphologies.

We included 6353 athletes (median (IQR) age: 19 (16-23) years; 2556 white, 2071 mixed-race and 1726 black individuals). ER patterns appeared in 2552 (40.2%) players. The most common ER morphologies with ST-segment elevation (STE) were a classic J-wave with ascending ST-segment (1275; 20.1%) and a discrete J-point with ascending ST-segment (735; 11.6%) in leads V4-V6. Without STE, the most frequent patterns were a slur on the downslope of the R-wave with ascending ST- segment (760; 12%), a slur with horizontal ST-segment (335; 5.3%) and a J-wave (199; 3.1%) in leads II, III and aVF. ER was more prevalent in black (48.1%) than in white (34.4%) or mixed-race (40.6%) athletes. Over a mean follow-up period of 4.4±3.1 years, no cases of sudden cardiac death were identified.

Our findings do not suggest that ER patterns observed in male Brazilian soccer players are associated with sudden cardiac death. Given the role of Brazil in exporting soccer talent, our results may help guide athlete assessments of ER worldwide.