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Electrocardiographic interpretation in athletes: the ‘Seattle Criteria’
  1. Jonathan A Drezner1,
  2. Michael John Ackerman2,
  3. Jeffrey Anderson3,
  4. Euan Ashley4,
  5. Chad A Asplund5,
  6. Aaron L Baggish6,
  7. Mats Börjesson7,
  8. Bryan C Cannon8,
  9. Domenico Corrado9,
  10. John P DiFiori10,
  11. Peter Fischbach11,
  12. Victor Froelicher4,
  13. Kimberly G Harmon1,
  14. Hein Heidbuchel12,
  15. Joseph Marek13,
  16. David S Owens14,
  17. Stephen Paul15,
  18. Antonio Pelliccia16,
  19. Jordan M Prutkin14,
  20. Jack C Salerno17,
  21. Christian M Schmied18,
  22. Sanjay Sharma19,
  23. Ricardo Stein20,
  24. Victoria L Vetter21,
  25. Mathew G Wilson22
  1. 1Department of Family Medicine, University of Washington, Seattle, Washington, USA
  2. 2Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Cardiovascular Diseases and Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Department of Athletics, University of Connecticut, Storrs, Connecticut, USA
  4. 4Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA
  5. 5Department of Family Medicine, Eisenhower Army Medical Center, Fort Gordon, Georgia, USA
  6. 6Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  7. 7Department of Cardiology, Swedish School of Sports and Health Sciences, Karolinska University Hospital, Stockholm, Sweden
  8. 8Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  9. 9Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padova, Italy
  10. 100Division of Sports Medicine, Department of Family Medicine, University of California Los Angeles, Los Angeles, California, USA
  11. 11Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
  12. 12Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
  13. 13Midwest Heart Foundation, Oakbrook Terrace, Illinois, USA
  14. 14Division of Cardiology, University of Washington, Seattle, Washington, USA
  15. 15Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA
  16. 16Department of Medicine, Institute of Sport Medicine and Science, Rome, Italy
  17. 17Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
  18. 18Division of Cardiology, Cardiovascular Centre, University Hospital Zurich, Zurich, Switzerland
  19. 19Department of Cardivascular Sciences, St George's University of London, London, UK
  20. 20Cardiology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil, Brazil
  21. 21Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  22. 22Department of Sports Medicine, ASPETAR, Qatar Orthopedic and Sports Medicine Hospital, Doha, Qatar
  1. Correspondence to Jonathan A Drezner, Department of Family Medicine, University of Washington, 1959 NE Pacific Street, Box 356390, Seattle, Washington 98195, USA; jdrezner{at}


Sudden cardiac death (SCD) is the leading cause of death in athletes during sport. Whether obtained for screening or diagnostic purposes, an ECG increases the ability to detect underlying cardiovascular conditions that may increase the risk for SCD. In most countries, there is a shortage of physician expertise in the interpretation of an athlete's ECG. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from abnormal findings suggestive of pathology. On 13–14 February 2012, an international group of experts in sports cardiology and sports medicine convened in Seattle, Washington, to define contemporary standards for ECG interpretation in athletes. The objective of the meeting was to develop a comprehensive training resource to help physicians distinguish normal ECG alterations in athletes from abnormal ECG findings that require additional evaluation for conditions associated with SCD.

  • Cardiology
  • Sporting injuries

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  • Funding None.

  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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