Introduction ECG in pre-participation screening in athletes is still debated. It is of relevant interest to have an automatic detection for this screening. 44’000 person a year are undergoing the screening at the age of 19 in Switzerland during Swiss Army conscription.
Objectives We hypothesise that is possible to perform automatic detection using the Seattle Criteria published for athlete screening based on a 10s 12-lead resting ECG.
Methods We performed a retrospective analysis of 274’468 digital standard 12-lead resting ECGs from military conscription acquired between 2008 and 2013. The Seattle Criteria were directly integrated into an automatic resting ECG measurement and interpretation software (ETM, SCHILLER AG) without any modification. Verification of proper implementation of the algorithm was done on the same dataset by visually and manually checking a randomly selected subset of abnormal (true positives) and normal ECGs (true negatives). The percentage of detection of any subtype as well as of the general finding ‘normal/abnormal ECG’ was calculated.
Results We found that the categories ’Q-wave pathologies’, ‘ST-segment depressions’ and ‘Left axis deviations’ have a detection rate higher than 1%. All other Seattle Criteria detection rates were lower. ‘Brugada-like pattern’ and ‘Profound sinus bradycardia’ were not detected. The overall detection rate of 6.5% of abnormal ECGs is comparable to the found value of 4.5% (2) among elite athletes (false positive rate of 4.2%).
Conclusion It is possible to perform automatic detection abnormal ECG using the published Seattle Criteria. The 6.47% abnormal ECGs correspond to 2’850 male individuals per year which would warrant a more profound clinical, and/or electrophysiological and genetic investigation to confirm or exclude the presence of an acquired or familial cardiac disease.
Drezner JA, Ackerman MJ, Anderson J et al. Electrocardiographic interpretation in athletes: the ‘Seattle criteria’. Br J Sport Med 2013 Feb;47(3):122–124.