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European Heart Journal Advance Access originally published online on July 10, 2007
European Heart Journal 2007 28(16):2006-2010; doi:10.1093/eurheartj/ehm219
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Prevalence of abnormal electrocardiograms in a large, unselected population undergoing pre-participation cardiovascular screening

Antonio Pelliccia1,*, Franco Culasso2, Fernando M. Di Paolo1, Domenico Accettura3, Rocco Cantore4, Walter Castagna5, Alberto Ciacciarelli6, Gioberto Costini7, Biagio Cuffari8, Enrico Drago9, Vittorio Federici10, Carlo Gabriele Gribaudo11, Giancarlo Iacovelli12, Luigi Landolfi13, Giuseppe Menichetti14, Umberto Olla Atzeni15, Attilio Parisi16, Angelo R. Pizzi17, Michele Rosa18, Fabio Santelli19, Franco Santilio20, Alberto Vagnini21, Maurizio Casasco22 and Luigi Di Luigi23

1 Institute of Sports Medicine and Science (CONI), Via dei Campi Sportivi, 46, 00197 Rome, Italy
2 Department of Experimental Medicine and Pathology, University of Rome ‘La Sapienza’, Rome, Italy
3 Sports Medicine Clinic, Italian Federation of Sports Medicine, Bari, Italy
4 Sports Medicine Clinic, Italian Federation of Sports Medicine, Potenza, Italy
5 Sports Medicine Clinic, Italian Federation of Sports Medicine, Catanzaro, Italy
6 Sports Medicine Clinic, Italian Federation of Sports Medicine, Verona, Italy
7 Sports Medicine Clinic, Italian Federation of Sports Medicine, Rieti, Italy
8 Sports Medicine Clinic, Italian Federation of Sports Medicine, Messina, Italy
9 Sports Medicine Clinic, Italian Federation of Sports Medicine, Bologna, Italy
10 Sports Medicine Clinic, Italian Federation of Sports Medicine, Ascoli Piceno, Italy
11 Sports Medicine Clinic, Italian Federation of Sports Medicine, Turin, Italy
12 Sports Medicine Clinic, Italian Federation of Sports Medicine, Viterbo, Italy
13 Sports Medicine Clinic, Italian Federation of Sports Medicine, Salerno, Italy
14 Sports Medicine Clinic, Italian Federation of Sports Medicine, Genoa, Italy
15 Sports Medicine Clinic, Italian Federation of Sports Medicine, Lecce, Italy
16 Sports Medicine Clinic, Italian Federation of Sports Medicine, Rome, Italy
17 Sports Medicine Clinic, Italian Federation of Sports Medicine, Viareggio, Italy
18 Sports Medicine Clinic, Italian Federation of Sports Medicine, Ragusa, Italy
19 Sports Medicine Clinic, Italian Federation of Sports Medicine, Ancona, Italy
20 Sports Medicine Clinic, Italian Federation of Sports Medicine, Taranto, Italy
21 Sports Medicine Clinic, Italian Federation of Sports Medicine, Pesaro, Italy
22 Postgraduate School in Sports Medicine, University of Brescia, FMSI Scientific Commission, Brescia, Italy
23 Endocrinology Unit, Department of Health Sciences, University of Rome ‘IUSM’, FMSI Scientific Commission, Rome, Italy

Received 20 November 2006; revised 27 April 2007; accepted 3 May 2007; online publish-ahead-of-print 10 July 2007.

* Corresponding author. Tel: +39 06 3685 9127. E-mail address: ant.pelliccia{at}libero.it

See page 1920 for the editorial comment on this article (doi:10.1093/eurheartj/ehm275)

Aims: The implementation of 12-lead ECG in the pre-participation screening of young athletes is still controversial and number of issues are largely debated, including the prevalence and spectrum of ECG abnormalities found in individuals undergoing pre-participation screening.

Methods and results: We assessed a large, unselected population of 32 652 subjects [26 050 (80%) males], prospectively examined in 19 clinics associated to Italian Sports Medicine Federation. Most were young amateur athletes, aged 8–78 years (median 17), predominantly students (68%), engaged predominantly in soccer (39%), volleyball or basketball (8% each), athletics (6%), cycling (5%), swimming (4%). The ECG patterns were evaluated according to commonly used clinical criteria. The 12-lead ECG patterns were considered normal in 28 799 of the 32 652 athletes (88.2%) and abnormal in 3853 (11.8%). The most frequent abnormalities included prolonged PR interval, incomplete right bundle branch block (RBBB) and early repolarization pattern (total 2280, 7.0%). Distinct ECG abnormalities included deeply inverted T-waves in > 2 precordial and/or standard leads (751, 2.3%), increased R/S wave voltages suggestive of LV hypertrophy (247, 0.8%), conduction disorders, i.e. RBBB (351, 1.0%), left anterior fascicular block (162, 0.5%), and left bundle branch block (19, 0.1%). Rarely, cardiac pre-excitation pattern (42, 0.1%) and prolonged QTc interval (1, 0.03%) were found.

Conclusion: In a large, unselected population of young athletes undergoing pre-participation screening, the prevalence of markedly abnormal ECG patterns, suggestive for structural cardiac disease, is low (<5% of the overall population) and should not represent obstacle for implementation of 12-lead ECG in the pre-participation screening program.

Key Words: pre-participation screening • electrocardiogram


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