British Journal of Sports Medicine Table 1. Abnormal ECG fi ndings in athletes Abnormal ECG fi nding Defi nition T-wave inversion ST segment depression Pathologic Q waves Complete left bundle branch block Intraventricular conduction delay Left axis deviation Left atrial enlargement Right ventricular Ventricular pre-excitation Long QT interval* QTc≥480 ms (female) QTc≥500 ms (marked QT prolongation) Short QT Brugada-like ECG pattern Profound sinus bradycardia Atrial tachyarrhythmias Premature ventricular contractions >1 mm in depth in two or more leads V2–V6, II and aVF, or I and aVL (excludes III, aVR and V1) ≥0.5 mm in depth in two or more leads >3 mm in depth or >40 ms in duration in two or more leads (except for III and aVR) QRS ≥120 ms, predominantly negative QRS complex in lead V1 (QS or rS), and upright monophasic R wave in leads I and V6 Any QRS duration ≥140 ms −30° to −90° Prolonged P wave duration of >120 ms in leads I or II with negative portion of the P wave ≥1 mm in depth and ≥40 ms in duration in lead V1 hypertrophy pattern R−V1+S−V5>10.5 mm AND right axis deviation >120° PR interval <120 ms with a delta wave (slurred upstroke in the QRS complex) and wide QRS (>120 ms) QTc≥470 ms (male) interval* QTc≤320 ms High take-off and downsloping ST segment elevation followed by a negative T wave in ≥2 leads in V1–V3 <30 BPM or sinus pauses ≥ 3 s Supraventricular tachycardia, atrial-fi brillation, atrial-fl utter ≥2 PVCs per 10 s tracing Couplets, triplets and non-sustained ventricular tachycardia Note: These ECG fi ndings are unrelated to regular training or expected physiological adaptation to exercise, may suggest the presence of pathological cardiovascular disease, and require further diagnostic evaluation. *The QT interval corrected for heart rate is ideally measured with heart rates of 60–90 bpm. Consider repeating the ECG after mild aerobic activity for borderline or abnormal QTc values with a heart rate <50 bpm. checklist of fi ndings to guide ECG interpretation for physicians, including new learners. The criteria defi ne ECG fi ndings that warrant further cardiovascular evaluation for disorders that predispose to SCD. The criteria were developed with consideration of ECG interpretation in the context of an asymptomatic athlete age 14–35. An athlete is defi ned as an individual who engages in regular exercise or training for sport or general physical fi tness, typically with a goal of improving performance. In the presence of personal cardiac symptoms or a family history that is positive for genetic cardiovascular disease or premature SCD, the criteria may require modifi cation. Physicians also may choose to deviate from consensus standards based on their experience or practice setting. 24 Sport & Geneeskunde | maart 2013 | nummer 1 The evaluation of ECG abnormalities is performed ideally in consultation with a specialist with knowledge and experience in athlete’s heart and disorders associated with SCD in young athletes. As new scientifi c data become available, revision of the criteria may further improve the accuracy of ECG interpretation within the athletic population. Conclusions Prevention of SCD in athletes remains a highly visible topic in sports medicine and cardiology. Cardiac adaptation and remodelling from regular athletic training produces common ECG alterations that could be mistaken as abnormal. Whether performed for screening or diagnostic purposes as part of the cardiac evaluation in athletes, it is critical Pagina 23
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