Comparison of cardiac characteristics of two high-risk sports associated with sudden cardiac death

Abstract Introduction Basketball and football are among the sports with the highest reported incidence of sudden cardiac death (SCD). Accurate identification of high-risk individuals is essential to reduce the risk of SCD in athletes harbouring life-threatening cardiac conditions. This study describes the ECG characteristics of elite British basketball players and compares the prevalence of ECG abnormalities with a large cohort of elite British football players. Methods A cohort of 310 elite British basketball players competing at national level (mean age 18.4 ± 0.9 years) underwent cardiovascular screening with a health questionnaire, 12-lead ECG and echocardiography when indicated between 2021 and 2024. Among basketball players, 166 (54%) were male, 148 (48%) were White and 154 (50%) were of Black ethnicity. ECGs were retrospectively analysed according to the International Criteria for ECG Interpretation in Athletes and compared with an age-, ethnicity- and sex-matched cohort of elite football players screened through the mandatory Football Association cardiac screening programme. Results Abnormal ECG findings, as defined by the International Criteria, were identified in 6.1% of basketball players compared with 2.0% of football players (p0.001). Basketball players demonstrated a higher prevalence of abnormal T-wave inversion (TWI) (5.2% vs 1.7%; p0.001), abnormal corrected QT intervals (1.0% vs 0.3%; p=0.012), atrial enlargement (4.5% vs 2.2%; p=0.033), first-degree atrioventricular block (6.1% vs 3.2%; p=0.007) and axis deviation (2.6% vs 1.2%; p=0.056) than football players. Among Black athletes, the prevalence of abnormal TWI was similar in basketball and football players (4.5% vs 4.1%; p=1.0). Black basketball players had a higher prevalence of right ventricular hypertrophy compared with their White counterparts (2.6% vs 0%; p=0.141), mirroring findings in football players (3.7% vs 2.2%; p=0.004). White basketball players had a higher prevalence of left ventricular hypertrophy than Black basketball players (62.8% vs 55.2%; p=0.218), with similar patterns observed in football players (24.6% vs 17.2%; p0.0001). Black basketball players had a lower prevalence of left atrial enlargement than Black football players (0.6% vs 5.7%; p0.001). No cases of inherited cardiac disease or SCD were reported. Conclusions Using the International Criteria, ECG abnormalities were detected in 6.1% of elite basketball players compared with 2.0% of elite footballers. These findings demonstrate higher ECG false-positive rates in basketball players and support the need for sport-specific ECG interpretation criteria to enhance diagnostic accuracy for cardiac disease and optimise cardiovascular care across athlete subgroups.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.