European Heart Journal Advance Access published online on November 20, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp473
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Recommendations for interpretation of 12-lead electrocardiogram in the athlete
1 Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Via Giustiniani,2, Padova 35121, Italy
2 Institute for Sports Sciences, Rome, Italy
3 Cardiovascular Rehabilitation Unit, KU Leuven, Leuven, Belgium
4 King's College Hospital, London, UK
5 New England Medical Center, Boston, MA, USA
6 Department of Medical-Diagnostic Sciences, University of Padua, Padua, Italy
7 Civil Hospital, Conegliano, Italy
8 University of Medicine and Dentistry, RWJ Medical School, New Brunswick, NJ, USA
9 Division of Inherited Cardiovascular Diseases, University of Athens, Greece
10 Department of Medicine, Sahlgrens University Hospital/Östra, Gothenburg, Sweden
11 Department Heart Disease, Haukeland University Hospital, Bergen, Norway
12 Sport Medicine, University of Rennes, Rennes, France
13 Sports Medicine, Aristotle University, Thessaloniki, Greece
14 Wellness Medical Center, Stockport, UK
15 Department of Cardiology, Maxima Medical Centre, Veldhoven, Netherlands
16 Heart Center NRW, University Hospital, Bad Oeynhausen, Germany
17 Department Cardiology, Nijmegen, The Netherlands
18 Klinikk Ullevål Sykehus, Oslo, Norway
19 Department of Family Medicine, University of Washington, Seattle, WA, USA
20 Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
21 Favaloro Foundation, Buenos Aires, Argentina
22 Department of Cardiology, Fondazione IRCCS Policlinico, San Matteo, Pavia
23 Exercise Pathophysiology Research Laboratory, Hospital de Clinicas Porto Alegre, Porto Alegre, Brazil
24 Sports Medicine Department, Institute of Internal Medicine and Geriatrics, Catholic University of Sacred Heart, Rome, Italy
25 The Heart Hospital, University College of London, London, UK
Received 20 July 2009; revised 22 September 2009; accepted 4 October 2009 * Corresponding author. Tel: +39 49 821 2458, Fax: +39 49 821 2309, Email: domenico.corrado{at}unipd.it
Cardiovascular remodelling in the conditioned athlete is frequently associated with physiological ECG changes. Abnormalities, however, may be detected which represent expression of an underlying heart disease that puts the athlete at risk of arrhythmic cardiac arrest during sports. It is mandatory that ECG changes resulting from intensive physical training are distinguished from abnormalities which reflect a potential cardiac pathology. The present article represents the consensus statement of an international panel of cardiologists and sports medical physicians with expertise in the fields of electrocardiography, imaging, inherited cardiovascular disease, cardiovascular pathology, and management of young competitive athletes. The document provides cardiologists and sports medical physicians with a modern approach to correct interpretation of 12-lead ECG in the athlete and emerging understanding of incomplete penetrance of inherited cardiovascular disease. When the ECG of an athlete is examined, the main objective is to distinguish between physiological patterns that should cause no alarm and those that require action and/or additional testing to exclude (or confirm) the suspicion of an underlying cardiovascular condition carrying the risk of sudden death during sports. The aim of the present position paper is to provide a framework for this distinction. For every ECG abnormality, the document focuses on the ensuing clinical work-up required for differential diagnosis and clinical assessment. When appropriate the referral options for risk stratification and cardiovascular management of the athlete are briefly addressed.
Key Words: Athlete's heart • Cardiomyopathy • Electrocardiogram • Ion-channel disease • Sudden death • Ventricular fibrillation • Ventricular tachycardia