Interpretation of the Electrocardiogram of Young Athletes

Although no detailed guidance for the interpretation of the athlete’s ECG exists, many physicians will be called on to interpret an athlete’s ECG.A principal obstacle to such interpretation is the difficulty in distinguishing abnormal patterns from physiological effects of training. Many clinical and ECG findings that may be a cause of concern in the general population are normal for athletes. In addition, the test characteristics of the ECG for different findings vary according to age, sex, ethnicity, sport, and level of training. In particular, different challenges exist for younger athletes because of the evolution of the ECG with age. This is further complicated by historical inconsistencies in the definition of ECG abnormalities and the uncertainty about criteria for final diagnosis of several diseases in secondary testing. Finally, low disease prevalence limits the positive predictive value of many ECG criteria, even for those with otherwise favorable sensitivity and specificity. Although this document focuses in large part on the diagnostic gray area presented by ECG screening, we have where possible included suggestions for secondary testing strategies. Current recommendations for patients diagnosed with cardiomyopathy or channelopathy are clearly against participation in high-level or competitive exercise.