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Published on 17.01.2018
Table 1: Normal ECG findings in athletes (adapted from Sharma et al., 2017, International Recommendations for Electrocardiographic Interpretation in Athletes [2]). | |
ECG Feature | Definition |
Left ventricular hypertrophy | Isolated S wave in V1 + R wave in V5 or V6 >3.5 mV |
Right ventricular hypertrophy | Isolated R wave in V1 + S wave in V5 or V6 >1.1 mV |
Incomplete right bundle-branch block | rSR’ pattern in lead V1 and an S wave wider than R wave in lead V6 with QRS duration <120 ms |
Sinus bradycardia | ≥30 bpm |
Sinus arrhythmia | Heart rate increase during inspiration |
Ectopic atrial rhythm | P waves of different morphology to sinus P wave |
Junctional escape rhythm | QRS narrow and faster than P wave |
1º atrioventricular block | Prolonged PR interval up to 400 ms |
Mobitz II 2º atrioventricular block | Progressive prolongation of PR interval with eventual non-conducted P wave and absent QRS |
Table 2: Abnormal ECG findings in athletes (adapted from Sharma et al., 2017, International Recommendations for Electrocardiographic Interpretation in Athletes [2]). | |
ECG Feature | Definition |
T wave inversion | >1 mm in depth in ≥2 contiguous leads (excluding III and aVR) |
Anterior: | V2–V4 excluding; – V2–V4 with preceding J point elevation and convex ST elevation in Black athletes – Athletes age <16 with T wave inversion in V1–V3; and biphasic T waves in only V3 |
Lateral: | I and aVL, V5 and/or V6 (only one lead of T wave inversion required in V5 or V6) |
Anterolateral: | II and aVF, V5–V6 |
Inferior: | II and aVF |
ST depression | ≥0.5 mm in depth in ≥2 contiguous leads |
Pathological Q waves | Q/R ratio ≥0.25 or ≥40 ms in duration in ≥2 leads (excluding III and aVR) |
Complete left bundle branch block | QRS >120 ms, predominantly negative QRS complex in lead V1 and upright notched or slurred R wave in leads I and V6 |
Profound Interventricular conduction delay | QRS ≥140 ms |
Epsilon wave | Small notch or positive deflection between the end of the QRS and T wave in V1–V3 |
Ventricular pre-excitation | PR interval <120 ms with delta wave & QRS ≥120 ms |
Prolonged QT | QTc >470 ms males QTc >480 ms females |
Type I Brugada pattern | Coved pattern: ST segment elevation ≥2 mm which is downsloping followed by a negative symmetric T wave in V1–V3 |
Profound sinus bradycardia | <30 beats/min or sinus pauses ≥3 s |
Profound first degree atrioventricular block | PR ≥400 ms |
Mobitz II 2º atrioventricular block | Systematic and intermittent non-conducted P waves |
3º atrioventricular block | Complete atrioventricular dissociation, bradycardia and often QRS >120 ms |
Atrial tachyarrhythmias | Atrial fibrillation, atrial flutter, supra ventricular tachycardia |
Premature ventricular complexes | ≥2 in a 10 second trace |
Ventricular arrhythmias | Couplets, triplets and non-sustained ventriclar tachycardia |
Table 3: Borderline ECG findings in athletes (adapted from Sharma et al., 2017, International Recommendations for Electrocardiographic Interpretation in Athletes [2]). | |
ECG Feature | Definition |
Left axis deviation | –30º to +90º |
Left atrial enlargement | P wave duration ≥120 ms in I/II with negative portion P wave ≥1 mm in amplitude and ≥40 ms in duration in V1 |
Right axis deviation | >120º |
Complete RBBB | rSR’ pattern in lead V1 and an S wave wider than R wave in lead V6 with QRS duration ≥120 ms |
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