Table 1 summarises a list of abnormal ECG findings unrelated to athletic training that may suggest the presence of an underlying cardiomyopathy and should trigger additional evaluation in an athlete. In this paper, abnormal ECG findings are presented relative to the most common cardiomyopathies associated with SCD in athletes: hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), dilated cardiomyopathy (DCM) and left-ventricular non-compaction (LVNC). 10 A review of normal ECG findings in athletes is presented separately. The objective of the meeting was to help physicians distinguish normal ECG alterations in athletes from abnormal ECG findings that require additional evaluation for conditions that predispose to SCD. On 13–14 February 2012, an international group of experts in sports cardiology and sports medicine convened in Seattle, Washington, to define contemporary standards for ECG interpretation in athletes. Several reports have outlined ECG criteria intended to distinguish normal ECG findings in athletes from ECG abnormalities requiring additional evaluation. Initial testing for further evaluation of abnormal ECG findings is also presented.Ī challenge in the use of ECG for screening or diagnostic evaluations in athletes is the ability to accurately differentiate findings suggestive of a potentially lethal cardiovascular disorder from benign physiological adaptations occurring as the result of regular and sustained intensive training (ie, athlete's heart). This paper will review the principal ECG findings associated with the most common forms of cardiomyopathy relevant to the care of the young athlete. Therefore, it is of paramount importance that clinicians responsible for ECG interpretation in athletes be familiar with key findings associated with underlying diseases of the heart muscle. Although a definitive diagnosis may require extensive evaluation by a cardiovascular specialist, the 12-lead ECG is commonly abnormal among athletes with an underlying cardiomyopathy. 1–3 Athletes with an underlying cardiomyopathy may present with disease-related symptoms or may be asymptomatic and thus only identified by abnormal testing during pre-participation screening. As a family of related diseases, the cardiomyopathies are the leading cause of sudden cardiac death (SCD) in young competitive athletes. The cardiomyopathies are a diverse group of heart muscle diseases that are defined and subdivided in clinical practice by different structural and functional characteristics. Jonathan A Drezner, Department of Family Medicine, University of Washington, 1959 NE Pacific Street, Box 356390, Seattle, Washington 98195, USA 23 Department of Sports Medicine, ASPETAR, Qatar Orthopedic and Sports Medicine Hospital, Doha, Qatar.22 Cardiology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.George's University of London, London, UK 21 Department of Cardivascular Sciences, St.20 Division of Cardiology, University Hospital Zurich, Zurich, Switzerland.19 Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA.18 Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA.17Midwest Heart Foundation, Oakbrook Terrace, Illinois, USA.16 Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.15 Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.14 Division of Sports Medicine, University of California Los Angeles, Los Angeles, California, USA.13 Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.12 Department of Family Medicine, Eisenhower Army Medical Center, Fort Gordon, Georgia, USA.11 Department of Athletics, University of Connecticut, Storrs, Connecticut, USA.10 Divisions of Cardiovascular Diseases and Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA.9 Departments of Medicine, Pediatrics, and Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA.8 Department of Medicine, Institute of Sport Medicine and Science, Rome, Italy.7 Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
6 Division of Cardiology, University of Washington, Seattle, Washington, USA.5 Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padova, Italy.4 Department of Cardiology, Swedish School of Sports and Health Sciences, Karolinska University Hospital, Stockholm, Sweden.3 Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.2 Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA.1 Department of Family Medicine, University of Washington, Seattle, Washington, USA.
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