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Recommendations for interpretation of 12-lead electrocardiogram in the athlete

Domenico Corrado, Antonio Pelliccia, Hein Heidbuchel, Sanjay Sharma, Mark Link, Cristina Basso, Alessandro Biffi, Gianfranco Buja, Pietro Delise, Ihor Gussac, Aris Anastasakis, Mats Borjesson, Hans Halvor Bjørnstad, François Carrè, Asterios Deligiannis, Dorian Dugmore, Robert Fagard, Jan Hoogsteen, Klaus P. Mellwig, Nicole Panhuyzen-Goedkoop, Erik Solberg, Luc Vanhees, Jonathan Drezner, N.A. Mark Estes, Sabino Iliceto, Barry J. Maron, Roberto Peidro, Peter J. Schwartz, Ricardo Stein, Gaetano Thiene, Paolo Zeppilli, William J. McKenna
DOI: http://dx.doi.org/10.1093/eurheartj/ehp473 243-259 First published online: 21 November 2009

Abstract

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.

  • Athlete's heart
  • Cardiomyopathy
  • Electrocardiogram
  • Ion-channel disease
  • Sudden death
  • Ventricular fibrillation
  • Ventricular tachycardia
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