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August 25, 2025JACC AdvancesOpen Access

Prevalence and Outcomes of Competitive Athletes From the United States With Electrocardiographic Athletic Anterior Early Repolarization

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Key result

The athletic anterior early repolarization pattern was significantly more prevalent among Black athletes compared to non-Black athletes (1.91% vs 0.48%), with no adverse cardiovascular events or structural pathology observed in either group.

Why the study?

Data defining the prevalence and clinical outcomes of athletic anterior early repolarization among non-Black athletes are limited.

Does the athletic anterior early repolarization pattern on ECG predict structural cardiac pathology or adverse cardiovascular events in Black and non-Black competitive athletes?

Population

6,177 screening athletic ECGs from U.S. competitive athletes aged 15 to 25 years

Comparison

Athletes with athletic anterior ERP vs without, and Black vs non-Black athletes

Design

Multicenter retrospective analysis

Follow-up

177 athlete-years

Authors

ARAustin RimGeneral / Preventive / LipidsPHPaishiun Nelson HsiehMassachusetts General HospitalPPParth PatelCatholic Medical Center

Discussion

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Member takes

Implication

Supports considering the pattern benign across races during screening; leaves open need for prospective validation before practice change.

Study Design

Type

Observational (n=6,177)

Multicenter

Yes

Structured PICO

Does the athletic anterior early repolarization pattern on ECG predict structural cardiac pathology or adverse cardiovascular events in Black and non-Black competitive athletes?

P
Population
6,177 competitive athletes aged 15 to 25 years undergoing preparticipation cardiac screening across four U.S. clinical sites, followed for a total of 177 athlete-years.
E
Exposure
Presence of athletic anterior early repolarization pattern (ERP) on screening ECG
C
Comparator
Athletes without the athletic anterior ERP, and comparison between Black and non-Black athletes with the pattern
O
Outcome
Prevalence of the athletic anterior early repolarization pattern (ERP) and incidence of adverse cardiovascular events or structural cardiac pathology over longitudinal follow-uphard clinical

Main Result

Absolute Event Rate: 1.91% vs 0.48%

p-value: p=<0.001

The athletic anterior early repolarization pattern on ECG is a benign finding in both Black and non-Black competitive athletes, challenging the practice of using race-based criteria for further cardiac evaluation.

Limitations

  • ECGs were identified retrospectively, and subsequent clinical evaluations were not standardized across sites, resulting in incomplete imaging data (40% did not have echocardiography).
  • Lack of access to all primary cardiac imaging data precluded blinded quantitative and qualitative assessments.
  • Clinical surveillance was limited to the timeframe of the study without ongoing prospective follow-up.
  • Possible incomplete capture of all athlete screening ECGs obtained at the sites during the study period.
  • Sample size precluded more detailed analyses regarding relationships with the athletic anterior ERP among non-Black racial and ethnic subgroups.
  • Baseball and soccer were the primary professional sports included, which may have affected the reported prevalence by sporting discipline.
  • Retrospective design with non-standardized clinical evaluations
  • 40% of athletes with athletic anterior ERP did not have echocardiography performed
  • Lack of access to primary cardiac imaging data for blinded assessment
  • Clinical surveillance limited to study timeframe without ongoing prospective follow-up
  • Sample size precluded detailed analyses of non-Black subgroups

Cite This Study

Rim et al. (2025) conducted an observational in Competitive athletes undergoing cardiac screening (n=6,177). Self-identified Black race vs. Self-identified non-Black race was evaluated on Prevalence of athletic anterior early repolarization pattern (ERP) (p=<0.001). The athletic anterior early repolarization pattern was significantly more prevalent among Black athletes compared to non-Black athletes (1.91% vs 0.48%), with no adverse cardiovascular events or structural pathology observed in either group.

synapsesocial.com/papers/6a8991af0e1a8f7244fd4e2ahttps://doi.org/10.1016/j.jacadv.2025.102102
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Electrocardiographic and Echocardiographic Findings in Black Athletes: A General Review2019 · 9 citations
  2. 2Electrocardiographic anterior T-wave inversion in athletes of different ethnicities: differential diagnosis between athlete's heart and cardiomyopathy2015 · 119 citations
  3. 3Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities: A Scientific Statement From the American Heart Association and American College of Cardiology2025 · 65 citations
  4. 4State of Disparities in Cardiovascular Health in the United States2005 · 1,221 citations
  5. 5Clinical Considerations for Competitive Sports Participation for Athletes With Cardiovascular Abnormalities2025 · 135 citations