British Journal of Sports Medicine the ‘Seattle Criteria’ Electrocardiographic interpretation in athletes BJSM Jonathan A Drezner, Michael John Ackerman, Jeffrey Anderson, Euan Ashley, Chad A Asplund, Aaron L Baggish, Mats Börjesson, Bryan C Cannon, Domenico Corrado, John P DiFiori, Peter Fischbach, Victor Froelicher, Kimberly G Harmon, Hein Heidbuchel, Joseph Marek, David S Owens, Stephen Paul, Antonio Pelliccia, Jordan M Prutkin, Jack C Salerno, Christian M Schmied, Sanjay Sharma, Ricardo Stein, Victoria L Vetter, Mathew G Wilson This document was developed in collaboration between the American Medical Society for Sports Medicine (AMSSM), the Section on Sports Cardiology of the European Association for Cardiovascular Prevention and Rehabilitation (EACPR), a registered branch of the European Society of Cardiology (ESC), the FIFA Medical Assessment and Research Center (F-MARC), and the Pediatric & Congenital Electrophysiology Society (PACES). Abstract Sudden cardiac death (SCD) is the leading cause of death in athletes during sport. Whether obtained for screening or diagnostic purposes, an ECG increases the ability to detect underlying cardiovascular conditions that may increase the risk for SCD. In most countries, there is a shortage of physician expertise in the interpretation of an athlete’s ECG. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from abnormal fi ndings suggestive of pathology. On 13– 14 February 2012, an international group of experts in sports cardiology and sports medicine convened in Seattle, Washington, to defi ne contemporary standards for ECG interpretation in athletes. The objective of the meeting was to develop a comprehensive training resource to help physicians distinguish normal ECG alterations in athletes from abnormal ECG fi ndings that require additional evaluation for conditions associated with SCD. pretation is an important skill for physicians involved in the cardiovascular care of athletes. Distinguishing normal from abnormal A challenge in the interpretation of an athlete’s ECG is the ability to accurately differentiate fi ndings suggestive of a potentially lethal cardiovascular disorder from benign physiological adaptations occurring as the result of regular, intense training (ie, athlete’s heart). Several reports have outlined contemporary ECG criteria intended to distinguish normal ECG fi ndings in athletes from ECG abnormalities requiring additional evaluation.3–8 Despite the publication of these consensus guidelines, most Introduction Cardiovascular-related sudden death is the leading cause of mortality in athletes during sport.1 2 The majority of disorders associated with increased risk of sudden cardiac death (SCD), such as cardiomyopathies and primary electrical diseases, are suggested by abnormal fi ndings present on a 12-lead ECG. ECG interpretation in athletes requires careful analysis to properly distinguish physiological changes related to athletic training from fi ndings suggestive of an underlying pathological condition. Whether used for the diagnostic evaluation of cardiovascular-related symptoms, a family history of inheritable cardiac disease or premature SCD, or for screening of asymptomatic athletes, ECG inter22 Sport & Geneeskunde | maart 2013 | nummer 1 sports medicine and cardiology training programmes lack a standard educational curriculum on ECG interpretation in athletes. The impact of standardised criteria Studies demonstrate that without further education the ability of many physicians to accurately interpret an athlete’s ECG is relatively poor and may lead to an unacceptable rate of false-positive interpretations and unnecessary secondary evaluations.9,10 However, providing physicians standardised criteria with which to evaluate an ECG considerably improves accuracy.10 In a study involving physicians across different specialties, use of a simple two-page Pagina 21
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