Background The European Society of Cardiology (ESC) released recommendations in 2010 for the interpretation of 12 lead electrocardiogram (ECG) in athletes. In 2013, the ‘Seattle Criteria’ was published with the aim to improve sensitivity of ECG screening.

Objective To compare the sensitivity of these two criteria for Indian athletes.

Design Cross sectional ECG data of the female athletes was collected during preparticipation screening. Any athletes with known cardiovascular disease was excluded from the study.

Setting ECG was recorded during their entry in the national camp in 2014–15 at the National Institute of Sports. Written informed consent was obtained before the study.

Patients (or Participants) The study population consisted of 63 elite female athletes (30 footballers and 33 from athletics) with mean age, height, weight, BMI of 22.71 (SD- 3.30) years, 157.38 (SD- 4.20) cm, 52.29 (SD- 3.87) kg, 21.77 (SD- 1.67) kg/m² respectively along with mean training age of 9.79 (SD- 3.08) years. None of them was having any known cardiovascular disorder.

Interventions (or Assessment of Risk Factors) The standard 12 lead ECG (RMS vesta 302i) was collected by a physician.

Main Outcome Measurements All ECGs had been evaluated and compared as per ESC and Seattle criteria by single investigator.

Results 12 (19%) [7(11.1%) with long QT syndrome and 5 (7.9%) with T wave inversion] and 3 (4.8%) [T wave inversion] athletes had abnormal ECG according to ESC and Seattle criteria respectively. Only one (1.5%) among them was detected cardiomyopathy by further investigations. The reduction was due to reclassification of 7 (11.1%) athletes with a redefined QTc interval, 2 (3.1%) with T wave inversion isolated to V_1–2.

Conclusions Using Seattle criteria for the athletes of Indian origin, the false positive ECG has been reduced from 17.5% to 3.3% but still the same athlete with cardiac abnormality can be identified.