Criteria for interpretation of the athlete's ECG: A critical appraisal

Zorzi, Alessandro; Vio, Riccardo; Bettella, Natascia; Corrado, Domenico

doi:10.1111/pace.14001

Cited by 11 publications

(8 citation statements)

References 59 publications

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“…The presence of LQRSV is an unexpected finding in an athlete because the physiologic ventricular remodelling induced by exercise conditioning, with enlargement of LV cavity and increased LV mass, is typically associated with an increase in QRS voltages. 8 …”

Section: Discussionmentioning

confidence: 99%

“…The current International recommendations for interpretation of the athlete’s ECG aim to differentiate the electrical changes that reflect the physiologic structural and neuro-autonomic cardiac remodelling induced by exercise conditioning, from training-unrelated abnormalities that are possibly associated with an underlying disease at risk of sudden cardiac death (SCD), based on the relative prevalence of the ECG abnormality in healthy athletes vs. patients with cardiovascular conditions. 8 , 9 However, the current criteria do not mention LQRSV, leaving open whether this ECG pattern deserves attention and requires further investigation. 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

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Prevalence and clinical significance of isolated low QRS voltages in young athletes

et al. 2022

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Aims Low QRS voltages (peak to peak <0.5 mV) in limb leads (LQRSV) on the athlete’s electrocardiogram (ECG) may reflect an underlying cardiomyopathy, mostly arrhythmogenic cardiomyopathy (ACM) or non-ischaemic left ventricular scar (NILVS). We studied the prevalence and clinical meaning of isolated LQRSV in a large cohort of competitive athletes. Methods and results The index group included 2229 Italian competitive athletes [median age 18 years (16–25), 67% males, 97% Caucasian] without major ECG abnormalities at pre-participation screening. Three control groups included Black athletes (N = 1115), general population (N = 1115), and patients with ACM or NILVS (N = 58). Echocardiogram was performed in all athletes with isolated LQRSV and cardiac magnetic resonance (CMR) in those with ventricular arrhythmias or echocardiographic abnormalities. The isolated LQRSV pattern was found in 1.1% index athletes and was associated with increasing age (median age 28 vs. 18 years; P < 0.001), elite status (71% vs. 34%; P < 0.001), body surface area, and body mass index but not with sex, type of sport, and echocardiographic left ventricular mass. The prevalence of isolated LQRSV was 0.2% in Black athletes and 0.3% in young individuals from the general population. Cardiomyopathy patients had a significantly greater prevalence of isolated LQRSV (12%) than index athletes, Black athletes, and general population. Five index athletes with isolated LQSRV and exercise-induced ventricular arrhythmias underwent CMR showing biventricular ACM in 1 and idiopathic NILVS in 1. Conclusions Unlike cardiomyopathy patients, the ECG pattern of isolated LQRSV was rarely observed in athletes. This ECG sign should prompt clinical work-up for exclusion of an underlying cardiomyopathy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence and clinical significance of isolated low QRS voltages in young athletes

et al. 2022

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“… Although multiple ECG abnormalities may be observed in ACM, T-wave inversion in the anterior leads V1-V4 is the most common and should always raise the suspicion of an underlying disease. In the athlete, anterior T-wave inversion should be considered normal only before pubertal development (“juvenile pattern of repolarization”) or in black individuals when preceded by J-point/ST-segment elevation (early repolarization variant typical of Afro-Caribbean athletes) [ 52 ]. The evaluation of an athlete should be multi-parametric: although no single test is diagnostic of ACM, the association of more than one abnormality at family history, resting, and exercise ECG and imaging increases the probability of a disease (Fig.…”

Section: Differentiating Acm and Athlete’s Heartmentioning

confidence: 99%

Role of Exercise as a Modulating Factor in Arrhythmogenic Cardiomyopathy

et al. 2021

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Purpose of Review The review addresses the role of exercise in triggering ventricular arrhythmias and promoting disease progression in arrhythmogenic cardiomyopathy (AC) patients and gene-mutation carriers, the differential diagnosis between AC and athlete’s heart and current recommendations on exercise activity in AC. Recent Findings AC is an inherited heart muscle disease caused by genetically defective cell-to-cell adhesion structures (mainly desmosomes). The pathophysiological hallmark of the disease is progressive myocyte loss and replacement by fibro-fatty tissue, which creates the substrates for ventricular arrhythmias. Animal and human studies demonstrated that intense exercise, but not moderate physical activity, may increase disease penetrance, worsen the phenotype, and favor life-threatening ventricular arrhythmias. It has been proposed that in some individuals prolonged endurance sports activity may in itself cause AC (so-called exercise-induced AC). Summary The studies agree that intense physical activity should be avoided in patients with AC and healthy gene-mutation carriers. However, low-to-moderate intensity exercise does not appear detrimental and these patients should not be entirely deprived from the many health benefits of physical activity.

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“…Twelve-lead ECG has traditionally been an integral part of non-invasive evaluation of patients with HCM [ 15 , 16 ]. The vast majority of patients show an abnormal ECG tracing, with a reported prevalence of ECG abnormalities of >90% [ 17 ].…”

Section: Hypertrophic Cardiomyopathymentioning

confidence: 99%

Hypertrophic Cardiomyopathy and Primary Restrictive Cardiomyopathy: Similarities, Differences and Phenocopies

Vio

Angelini

Basso

et al. 2021

JCM

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Hypertrophic cardiomyopathy (HCM) and primary restrictive cardiomyopathy (RCM) have a similar genetic background as they are both caused mainly by variants in sarcomeric genes. These “sarcomeric cardiomyopathies” also share diastolic dysfunction as the prevalent pathophysiological mechanism. Starting from the observation that patients with HCM and primary RCM may coexist in the same family, a characteristic pathophysiological profile of HCM with restrictive physiology has been recently described and supports the hypothesis that familiar forms of primary RCM may represent a part of the phenotypic spectrum of HCM rather than a different genetic cardiomyopathy. To further complicate this scenario some infiltrative (amyloidosis) and storage diseases (Fabry disease and glycogen storage diseases) may show either a hypertrophic or restrictive phenotype according to left ventricular wall thickness and filling pattern. Establishing a correct etiological diagnosis among HCM, primary RCM, and hypertrophic or restrictive phenocopies is of paramount importance for cascade family screening and therapy.

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Criteria for interpretation of the athlete's ECG: A critical appraisal

Cited by 11 publications

References 59 publications

Prevalence and clinical significance of isolated low QRS voltages in young athletes

Prevalence and clinical significance of isolated low QRS voltages in young athletes

Role of Exercise as a Modulating Factor in Arrhythmogenic Cardiomyopathy

Hypertrophic Cardiomyopathy and Primary Restrictive Cardiomyopathy: Similarities, Differences and Phenocopies

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