Standardised criteria for ECG interpretation in athletes: a practical tool.

Cardiovascular-related sudden death is the leading cause of mortality in athletes during sport. The majority of disorders associated with increased risk of sudden cardiac death (SCD), such as cardiomyopathies and primary electrical diseases, are suggested by abnormal findings present on an ECG. ECG interpretation in athletes requires careful analysis to properly distinguish physiological changes related to athlete’s heart from findings suggestive of an underlying pathological cardiac condition. Whether used for the diagnostic evaluation of cardiovascular-related symptoms, a family history of inheritable cardiac disease or SCD, or for screening of asymptomatic athletes, ECG interpretation is an important skill for physicians involved in the cardiovascular care of athletes. The purpose of this short report is to guide the clinician on the use of a two-page ECG criteria tool (Appendix, pages i7–i8). The science underpinning this instrument has been reported and demonstrates that providing standardised criteria to assist ECG interpretation in athletes significantly improves accuracy to distinguish normal from abnormal findings across physician specialties, even in physicians with little or no experience. The first page of the criteria tool consists of two tables. Table 1 lists each individual ECG criterion that should be considered abnormal, unrelated to athletic training, and warrants additional investigation for disorders predisposing to SCD. Table 2 lists the normal and physiological ECG changes commonly found in trained athletes that should not trigger additional testing. The second page of the tool (Appendix, page i8) displays several examples of uncommon ECG patterns.