Normal and abnormal QT interval duration and its changes in preadolescents and adolescents practicing sport

D’Ascenzi, Flavio; Anselmi, Francesca; Graziano, Francesca; Berti, Beatrice; Franchini, A; Bacci, Elodi; Ceccon, Chiara; Capitani, Massimo; Bonifazi, Marco; Mondillo, Sergio

doi:10.1093/europace/euz198

Cited by 8 publications

(8 citation statements)

References 19 publications

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“…15 All LQTS groups, both genotype-positive and negative, shortened their QTc by an average of 21 ms. Of note, most ECG studies in athletes point to longer QTc values compared with controls with a relatively modest, and clinically irrelevant, difference between 10 and 15 ms. 16 This probably accounts, at least in part, for the close to 20-ms shortening observed after the diagnosis-related reduction in physical activity among LQTS patients, who start from much longer baseline QTc values. A recent study 17 of adolescents practicing sports suggested, based on 5 subjects, that when QTc is >480 ms it does not normalize over time; our data do not support that view, provided, however, that detraining takes place.…”

Section: Clinical Factscontrasting

confidence: 99%

“…The baseline characteristics of the study population are summarized in Table 1. Males were 65%, mean age at presentation was 18±10 years [median, 14 (IQR, [12][13][14][15][16][17][18]], ranging from 6 to 56 years (19 subjects >40 years of age). Most (81%) were competitive athletes, whereas for 19% physical activity was limited to recreational sports.…”

Section: Study Populationmentioning

confidence: 99%

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Exercise Training-Induced Repolarization Abnormalities Masquerading as Congenital Long QT Syndrome

Dagradi¹,

Spazzolini²,

Castelletti³

et al. 2020

Circulation

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Background: The diagnosis of long QT syndrome (LQTS) is rather straightforward. We were surprised by realizing that, despite long-standing experience, we were making occasional diagnostic errors by considering as affected subjects that, over time, resulted as not affected. These individuals were all actively practicing sports, an observation which helped to design our study. Methods: We focused on subjects referred to our Center by Sports Medicine doctors with a suspicion of LQTS because of marked repolarization abnormalities on the ECG performed during the mandatory medical visit necessary in Italy to obtain the certificate of eligibility to practice sports. They all underwent our standard procedures involving both a resting and 12-lead ambulatory ECG, an exercise stress test, and genetic screening. Results: There were 310 such consecutive subjects, all actively practicing sports with many hours of intensive weekly training. Of them, 111 had a normal ECG, different cardiac diseases or were lost to follow-up and exited the study. Of the remaining 199, all with either clear QTc prolongation and/or typical repolarization abnormalities, 121 were diagnosed as affected based on combination of ECG abnormalities with positive genotyping (QTc 482±35 ms). Genetic testing was negative in 78 subjects but 45 were nonetheless diagnosed as affected by LQTS based on unequivocal ECG abnormalities (QTc 472±33 ms). The remaining 33, entirely asymptomatic and with a negative family history, following detraining showed an unexpected and practically complete normalization of the ECG abnormalities (their QTc shortened from 492±37 to 423±25 ms, p<0.001, and their Schwartz score went from 3.0 to 0.06). They were considered not affected by congenital LQTS and are henceforth referred to as "Cases". Furthermore, among them, those who resume a similarly heavy physical training showed reappearance of the repolarization abnormalities. Conclusions: It is not uncommon to suspect LQTS among individuals actively practicing sports, based on marked repolarization abnormalities. Among those who are genotype-negative, >40% normalize their ECG following detraining but the abnormalities tend to recur with resumption of training. These individuals are not affected by LQTS but could have a form of acquired LQTS. Care should be exercised to avoid diagnostic errors.

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Section: Clinical Factscontrasting

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Exercise Training-Induced Repolarization Abnormalities Masquerading as Congenital Long QT Syndrome

Dagradi¹,

Spazzolini²,

Castelletti³

et al. 2020

Circulation

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“…A similar evolution of the QTc interval in athletes over time has been previously described in the literature (23).…”

Section: Ecg Findings In Athletes Vs High-school Studentssupporting

confidence: 82%

Age-Related Electrocardiographic Characteristics of Male Junior Soccer Athletes

Sciarra

Biondi‐Zoccai

Maffessanti

et al. 2022

Front. Cardiovasc. Med.

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IntroductionVery limited data exist on normal age-related ECG variations in adolescents and no data have been published regarding the ECG anomalies induced by intensive training, which are relevant in pre-participation screening for sudden cardiac death prevention in the adolescent athletic population. The purpose of this study was to establish normal age-related electrocardiographic measurements (P wave duration, PR interval, QRS duration, QT, and QTc interval) grouped according to 2-year age intervals.MethodsA total of 2,151 consecutive healthy adolescent Soccer athletes (trained for a mean of 7.2 ± 1.1 h per week, 100% male Caucasians, mean age 12.4 ± 1.4 years, range 7–18) underwent pre-participation screening, which included ECG and transthoracic echocardiography in a single referral center.ResultsTheir heart rate progressively slowed as age increased (p < 0.001, ranging from 80.8 ± 13.2 to 59.5 ± 10.2 bpm), as expected. The P wave, PR interval, and QRS duration significantly increased in older age classes (p = 0.019, p = 0.001, and p < 0.001, respectively), and after Bonferroni's correction, the difference remained significant in all age classes for QRS duration. The QTc interval diminished progressively with increasing age (p = 0.003) while the QT interval increased progressively (p < 0.001).ConclusionsSignificant variations in the normal ECG characteristics of young athletes exist between different age groups related to increasing age and training burden, thus, age-specific reference values could be adopted, as already done for echocardiographic measurements, and may help to further discriminate potentially pathologic conditions.

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“…In recent years, the Fridericia correction formula has emerged as a more heart rate-independent alternative, but since it provides QTc values 25 ± 11 ms shorter than the Bazett formula, new reference values would be needed. 50,51 At present, we believe that the Bazett formula should continue to be used. A brief period of hyperventilation may be useful to raise the heart rate in athletes with profound sinus bradycardia.…”

Section: Qt Intervalmentioning

confidence: 99%

“…At low frequencies (heart rate <50 bpm) it underestimates the QTc, at high frequencies it overestimates it (heart rate >90 bpm). In recent years, the Fridericia correction formula has emerged as a more heart rate‐independent alternative, but since it provides QTc values 25 ± 11 ms shorter than the Bazett formula, new reference values would be needed 50,51 . At present, we believe that the Bazett formula should continue to be used.…”

Section: Areas Of Uncertaintymentioning

confidence: 99%

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

Zorzi

Vio

Bettella

et al. 2020

Pacing Clinical Electrophis

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The electrocardiogram (ECG) is cheap and widely available but its use as a screening tool for early identification of athletes with a cardiac disease at risk of sudden cardiac death is controversial because of presumed low specificity. In the last decade, several efforts have been made to improve the distinction between physiological and pathological ECG findings in the athlete, leading to continuous evolution of the interpretation criteria. The most recent 2017 International criteria grouped ECG changes into three categories: normal, borderline, and abnormal. Borderline findings warrant further investigations only when two or more are present while abnormal changes should always be considered as the sign of a possible underlying disease. This review encompasses the evolution of the athlete's ECG interpretation criteria and highlights areas of uncertainty that will need to be addressed by further studies.

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Normal and abnormal QT interval duration and its changes in preadolescents and adolescents practicing sport

Cited by 8 publications

References 19 publications

Exercise Training-Induced Repolarization Abnormalities Masquerading as Congenital Long QT Syndrome

Exercise Training-Induced Repolarization Abnormalities Masquerading as Congenital Long QT Syndrome

Age-Related Electrocardiographic Characteristics of Male Junior Soccer Athletes

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

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