DÄ internationalArchive1-2/2011Electrocardiogram in Athletes
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Changes in the resting electrocardiogram(ECG) as a result of training are common and can cause difficulties for the differential diagnosis. Recently updated guidelines from the European Society of Cardiology (ESC) differentiate between common, training-related and rare, potentially pathological changes (1). These new international recommendations were omitted from the article on the pre-participation examination for leisure time physical activity (2), presumably because they were not yet available at the time the manuscript was accepted. I wish to add them at this point.

The following changes on ECG are classed as training-related in the absence of other distinctive features: sinus bradycardia, 1st degree atrioventricular block, incomplete right bundle block, early repolarization, isolated increased QRS voltages (increased Sokolow-Lyon index). These changes may occur in up to 80% of athletes. The prevalence is highest in endurance athletes with physiological remodeling of the heart, but the changes may also be found in other athletes and are notably more common in men than in women, and in black people than in white (Caucasian) people (3, 4).

Isolated increased QRS voltages are responsible for 60% of training-related changes in athletes (4). In addition to cardiac adaptations , athletes often have favorable conditions for ECG leads owing to a lower proportion of body fat. Early repolarization of at least 0.1 mV, mostly located in the precordial leads (V2)V3–V4, is also common. In athletes of Afro-Caribbean origin, these ST elevations may be followed by negative T waves (3). As far as AV blocks are concerned, I would, by contrast to the authors, be very reticent to classify a 3rd degree AV block in elite athletes as normal (Box 3). I am not familiar with any such findings in athletes who are proven to be healthy.

It is to be expected that the current ESC recommendations will notably lower the rate of false positive findings on athletes’ ECGs.

DOI: 10.3238/arztebl.2011.0010a

Prof. em. Dr. med. Wilfried Kindermann

Universität des Saarlandes

Postfach 151150

66041 Saarbrücken, Germany

w.kindermann@mx.uni-saarland.de

1.
Corrado D, Pelliccia A, Heidbüchel H, et al.: Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J 2010; 31: 243–59. MEDLINE
2.
Löllgen H, Leyk D, Hansel J: The pre-participation examination for leisure time physical activity: general medical and cardiological
issues. Dtsch Arztebl Int 2010; 107(42): 742–9. VOLLTEXT
3.
Basavarajaiah S, Boraita A, Whyte G, et al.: Ethnic differences in left ventricular remodelling in highly-trained athletes: relevance to
differentiating physiologic left ventricular hypertrophy from
hypertrophic cardiomyopathy. J Am Coll Cardiol 2008; 51: 2256–62. MEDLINE
4.
Pelliccia A, Maron BJ, Culasso F, et al.: Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 2000; 102: 278–84.
MEDLINE
1.Corrado D, Pelliccia A, Heidbüchel H, et al.: Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J 2010; 31: 243–59. MEDLINE
2.Löllgen H, Leyk D, Hansel J: The pre-participation examination for leisure time physical activity: general medical and cardiological
issues. Dtsch Arztebl Int 2010; 107(42): 742–9. VOLLTEXT
3.Basavarajaiah S, Boraita A, Whyte G, et al.: Ethnic differences in left ventricular remodelling in highly-trained athletes: relevance to
differentiating physiologic left ventricular hypertrophy from
hypertrophic cardiomyopathy. J Am Coll Cardiol 2008; 51: 2256–62. MEDLINE
4.Pelliccia A, Maron BJ, Culasso F, et al.: Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 2000; 102: 278–84.
MEDLINE