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What's the big deal about T-wave inversion in athletes? A guide to clinical interpretation
  1. Mathew G Wilson1,2,3,
  2. François Carré4,5,6
  1. 1Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
  3. 3Research Institute of Sport and Exercise Sciences, University of Canberra, Australia
  4. 4Department of Physiology, Rennes1 University, Rennes, France
  5. 5Department of Sport Medicine, Pontchaillou Hospital, Rennes, France
  6. 6INSERM UMR 1099, Rennes, France
  1. Correspondence to Professor Mathew Wilson, Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, PO Box 29222, Qatar; mathew.wilson{at}aspetar.com

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The observation of T-wave inversion (TWI) on the resting 12-Lead ECG of an asymptomatic athlete is one of the most troublesome sports cardiology conundrums. TWI (except in leads aVR, III and V1, V1–V3 in young adolescent athletes (<16 years old) and in V1–V4 when preceded by domed ST segment in asymptomatic Afro-Caribbean athletes only) is rarely observed on the ECG of healthy athletes, whereas it is common in several cardiac diseases associated with sudden cardiac death. In 2011, we reported the case of an asymptomatic athlete with a family history of sudden death (unknown cause), presenting with deep TWI, who was provided with medical clearance for competitive sport due to lack of a definitive diagnosis of cardiac pathology.1 Three months after receiving clearance, however, the athlete had a transient loss of consciousness during exercise (training at his club) and was found to have a serious rhythm disturbance during intensive exercise on follow-up graded exercise testing. Consequently, the athlete was disqualified from all competitive sport.2

While sporting disqualification …

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