International recommendations for electrocardiographic interpretation in athletes

Abstract

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural, or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly over the last decade; pushed by a growing body of scientific data that both tests proposed criteria sets and establishes new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington, to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.

Influence of different dynamic sporting disciplines on right ventricular Structure and function in elite male athletes

“…Athletes were excluded if after the completion of a health questionnaire, consultant examination, 12-lead ECG, full echocardiographic examination and/or any other clinically relevant follow-up test they had a definitive or suggestive diagnosis of cardiovascular disease [19].…”

“…A standard resting 12-lead ECG (CardioExpress SL6, Spacelabs Healthcare, Washington US) was carried out in accordance with American Heart Association guidelines [19].…”

The acute impact of an ultramarathon on right heart: A 12‐lead ECG study

“…If the manually measured QT interval was >10 ms different than the computer's QT measurement, an average RR interval was determined and the QTc recalculated using the Bazett's formula, as recommended. 8 When performed manually, QT interval was measured in lead II or V5 using the teach-the-tangent method to avoid inclusion of a U wave. 8 P-wave amplitude and P-wave duration were measure in lead II in order to define left atrium enlargement (LAE) and right atrium enlargement (RAE) criteria.…”

“…8 When performed manually, QT interval was measured in lead II or V5 using the teach-the-tangent method to avoid inclusion of a U wave. 8 P-wave amplitude and P-wave duration were measure in lead II in order to define left atrium enlargement (LAE) and right atrium enlargement (RAE) criteria. LAE was defined as P-wave duration >120 ms or a negative portion of the P wave of ≥0.1 mV in depth and ≥40 ms in duration in lead V₁.…”

Tentative Screening Criteria for Short QT Interval in Children and Adolescents

“…8 A recent recommendation does not mention a cut-off for short QT interval and instead proposes that short QT interval be investigated only in the context of relevant clinical markers. 9 The rarity of SQTS is one of the reasons for the existence of different recommended cut-offs for short QTc. In a large study in apparently healthy people aged 14-35 years, the prevalence of QTc <320 ms was 0.14% (26 of HAZEKI D et al…”