EKG in athletes

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Overview

Corrado et al. have published an ESC consensus document on the screening of athletes for competitive sports.Corrado Besides a good medical history and examination, a 12 lead ECG is also part of the screening. They have set up special ECG criteria for participants in competitive sports (table 1). If one of the described findings are present on the ECG, the ECG is considered 'positive' and further evaluation is mandatory which can include echocardiography, 24-h ambulatory Holter monitoring, and exercise testing. ECG Features of cardiac diseases detectable at pre-participation screening in young competitive athletes are shown in table 2.

Prevalence of ECG abnormalities in competitive athletes has been studied by Pellicia et al.Pellicia(see table below). ECG abnormalities in their study increased with age and level of exercise. In young amateur athletes they found ECG abnormalities in about 7%, a number that rised to 40% in "adult elite athletes". Especially RBBB and left ventricular hypertrophy were often seen.

Recently fierce debate has been going on about whether an ECG should be part of the screening of apparently healthy young sporters. In Italy this screening is compulsory by law and this country is a strong advocate of the use of an ECG as part of this screening. However, othersChaitman have stated that costs are too high for the yield (expressed in dollars per prevented sudden cardiac death) and an ECG is not included in the screening protocol of the American Heart Association.MaronMyerburg

Criteria for a positive ECG

Table 1: Criteria for a positive 12-lead ECG

P wave	left atrial enlargement: negative portion of the P wave in lead V1 ≥ 0.1 mV in depth and ≥ 0.04 s in duration right atrial enlargement: peaked P wave in leads II and III or V1 ≥ 0.25 mV in amplitude
QRS complex	frontal plane axis deviation: right ≥ +120° or left –30° to –90°; increased voltage: amplitude of R or S wave in in a standard lead ≥2 mV, S wave in lead V1 or V2 ≥ 3 mV, or R wave in lead V5 or V6 ≥ 3 mV; abnormal Q waves ≥ 0.04 s in duration or ≥ 25% of the height of the ensuing R wave or QS pattern in two or more leads; right or left bundle branch block with QRS duration ≥ 0.12 s; R or R' wave in lead V1 ≥ 0.5 mV in amplitude and R/S ratio ≥ 1.
ST-segment, T-waves, and QT interval	ST-segment depression or T-wave flattening or inversion in two or more leads; prolongation of heart rate corrected QT interval (QTc) > 0.44 s in males and > 0.46 s in females.c
Rhythm and conduction abnormalities	premature ventricular beats or more severe ventricular arrhythmias; supraventricular tachycardias, atrial flutter, or atrial fibrillation; short PR interval (< 0.12 s) with or without ‘delta’ wave; sinus bradycardia with resting heart rate ≤ 40 beats/min;a first (PR ≥ 0.21 sb), second or third degree atrioventricular block.
aIncreasing less than 100 beats/min during limited exercise test. bNot shortening with hyperventilation or limited exercise test. cA recent study suggests athletes with a QTc > 500ms should be recommended not to participate in competitive sportsMossBasavarajaiah

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