Prevalence and significance of ECG abnormalities in athletes: Data from a multicenter Italian registry

The Italian pre-participation screening (PPS) protocol includes family and personal medical history, physical examination, and a 12‑lead electrocardiogram (ECG). The aim of this study was to evaluate the prevalence of selected ECG abnormalities in an unselected athletic population from a multicenter Italian registry, and to assess their association with at-risk cardiovascular conditions.

This multicenter registry prospectively enrolled 12,758 elite and amateur athletes (62% males; median age 22.5 years, range 14-55 years) undergoing PPS according to the Italian national protocol (COCIS, 2017). ECGs were interpreted according to the International Criteria for Electrocardiographic Interpretation in Athletes, with the addition of selected markers (low QRS voltages, QRS fragmentation, and early repolarization with horizontal or descending ST segment). ECG patterns suggestive of Brugada syndrome and ventricular pre-excitation, although observed, were not included in the analysis. All subjects with ECG abnormalities underwent a second-line diagnostic work-up.

A total of 129 abnormal ECGs were identified (1.01%). Among these, 25 athletes (19.3%) were disqualified because of an at-risk cardiovascular condition.

The prevalence of selected ECG abnormalities in this multicenter registry was lower than that reported in previous studies. However, this finding should be interpreted in the light of the selective ECG criteria adopted. The abnormalities investigated showed a relevant predictive value for identifying at-risk conditions in a real-world, predominantly non-elite population.