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Prevalence and Outcomes of Competitive Athletes From the United States With Electrocardiographic Athletic Anterior
Austin J Rim1, Paishiun Nelson Hsieh2, Parth Patel1
1Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
Background:
Early repolarization associated with T-wave inversions in the anterior leads (V1-V4) is considered a normal electrocardiographic (ECG) finding for athletes who self-identify as Black. To date, data defining the prevalence and clinical outcomes of this ECG pattern among non-Black athletes are limited.
Objectives:
The authors sought to determine the prevalence and outcomes of anterior early repolarization with T-wave inversions in a diverse, multicenter, and multisport cohort of U.S. competitive athletes.
Methods:
In a retrospective analysis of screening athletic ECGs (1993-2025) obtained across four U.S. clinical sites, the prevalence of the athletic anterior early repolarization pattern (ERP) and clinical outcomes were determined.
Results:
A total of 6,177 ECGs (1,203 [19.5%] Black athletes and 4,974 [80.5%] non-Black athletes; age range: 15 to 25 years) were reviewed. Of these, 47 athletes demonstrated athletic anterior ERP (prevalence = 0.76% [95% CI: 0.50% to 1.01%]); 23 athletes self-identified as Black (prevalence = 1.91% [95% CI: 1.21% to 2.87%]) and 24 as non-Black (prevalence = 0.48% [95% CI: 0.31% to 0.72%]). Among non-Black athletes, the racial and/or ethnic distribution was White (N = 12, 50%), Asian (N = 5, 20%), Hispanic (N = 5, 20%), Asian and White (N = 1, 4%), and Middle-Eastern (N = 1, 4%). Athletic anterior ERP was more common in sports with higher endurance and strength demands. Over 177 athlete-years of follow-up, there were no adverse cardiovascular events. Among non-Black athletes who proceeded with cardiac imaging (N = 18/24, 75%), no structural cardiac pathology or cardiomyopathy was reported.
Conclusions:
Athletic anterior ERP appears to be a benign finding irrespective of racial and/or ethnic constructs. Race-based terminology for competitive athletes with this ECG pattern should be avoided.
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