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Early Repolarization in Young Athletes: Prevalence and Sex-Specific Patterns
Birane A Kane1, Albane B R Maggio2, Cecilia Craviari1
1Cardiology Service, Geneva University Hospitals, Geneva, Switzerland.
Objective:
To determine the prevalence, characteristics, and sex differences of early repolarization pattern (ERP) in pediatric athletes.
Design:
Prospective observational study.
Setting:
Large popular race in Geneva, 2018 to 2024.
Participantsintotal,:
428 athletes aged 8 to 17 years, training ≥6 hours per week.
Interventions:
Participants underwent history, physical examination, and 12-lead electrocardiography (ECG) interpreted according to athlete-specific recommendations. ERP was defined using Macfarlane criteria.
Main Outcome Measures:
Prevalence and morphology of ERP, ECG parameters, and sex-related differences.
Results:
ERP was present in 62 athletes (14.5%), with similar prevalence in boys (16.4%) and girls (13.1%; P = 0.676). Notched ERP (40.0% vs 12.0%; P = 0.022) and ascending ST slopes (80.0% vs 52.2%; P = 0.041) were more frequent in boys, whereas slurred ERP and flat/descending slopes predominated in girls. Compared with athletes without ERP, those with ERP showed shorter QRS duration (85.4 ± 6.9 vs 89.9 ± 11.0 ms; P = 0.002), shorter QTc interval (415.1 ± 19.2 vs 423.5 ± 19.5 ms; P = 0.002), and more leftward P-wave axis. Normal ECG findings were more frequent in ERP athletes (98.3% vs 72.1%; P < 0.001).
Conclusions:
ERP occurred in 1 in 7 pediatric athletes and clustered with benign ECG adaptations. Boys more often exhibited notched ERP, girls slurred ERP, indicating sex-related morphological differences despite similar prevalence.
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