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Consensus statement
International criteria for electrocardiographic interpretation in athletes: Consensus statement
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  1. Jonathan A Drezner1,
  2. Sanjay Sharma2,
  3. Aaron Baggish3,
  4. Michael Papadakis2,
  5. Mathew G Wilson4,
  6. Jordan M Prutkin5,
  7. Andre La Gerche6,
  8. Michael J Ackerman7,8,9,10,11,
  9. Mats Borjesson12,13,
  10. Jack C Salerno14,
  11. Irfan M Asif15,
  12. David S Owens5,
  13. Eugene H Chung16,
  14. Michael S Emery17,
  15. Victor F Froelicher18,
  16. Hein Heidbuchel19,
  17. Carmen Adamuz4,
  18. Chad A Asplund20,
  19. Gordon Cohen21,22,
  20. Kimberly G Harmon1,
  21. Joseph C Marek23,
  22. Silvana Molossi24,25,
  23. Josef Niebauer26,
  24. Hank F Pelto1,
  25. Marco V Perez27,
  26. Nathan R Riding4,
  27. Tess Saarel28,29,
  28. Christian M Schmied30,
  29. David M Shipon31,
  30. Ricardo Stein32,
  31. Victoria L Vetter33,
  32. Antonio Pelliccia34,
  33. Domenico Corrado35,36,37
  1. 1 Department of Family Medicine, University of Washington, Seattle, Washington, USA
  2. 2 Cardiology Clinical Academic Group, St. George’s, University of London, London, UK
  3. 3 Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, US
  4. 4 Department of Sports Medicine, ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  5. 5 Division of Cardiology, University of Washington, Seattle, Washington, USA
  6. 6 Baker IDI Heart and Diabetes Institute, Melbourne, Australia
  7. 7 Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  8. 8 Department of Paediatric, Mayo Clinic, Rochester, Minnesota, USA
  9. 9 Department of Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
  10. 10 Department of Molecular Pharmacology, Mayo Clinic, Rochester, Minnesota, USA
  11. 11 Department of Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
  12. 12 Department of Neuroscience, Sahlgrenska University Hospital/Ostra Sahlgrenska Academy, Goteborg, Sweden
  13. 13 Department of Physiology, Sahlgrenska University Hospital/Ostra Sahlgrenska Academy, Goteborg, Sweden
  14. 14 Department of Pediatrics, University of Washington, Seattle, Washington, US
  15. 15 Department of Family Medicine, University of South Carolina, Greenville, USA
  16. 16 Division of Cardiology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA
  17. 17 Center of Cardiovascular Care in Athletics, Indiana University School of Medicine, Indianapolis, Indiana, USA
  18. 18 Department of Medicine, Stanford University, Stanford, California, USA
  19. 19 Hasselt University, Hasselt, Belgium
  20. 20 Georgia Southern University, Statesboro, Georgia, USA
  21. 21 Division of Paediatric Surgery, University of California, San Francisco School of Medicine, San Francisco, California, USA
  22. 22 Division of Cardiothoracic Surgery, University of California, San Francisco School of Medicine, San Francisco, California, USA
  23. 23 Advocate Heart Institute, Chicago, Illinois, USA
  24. 24 Division of Pediatric, Baylor College of Medicine, Houston, Texas, USA
  25. 25 Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
  26. 26 University Institute of Sports Medicine, Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
  27. 27 Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California, USA
  28. 28 Department of Pediatrics, Cleveland Clinic, Cleveland, Ohio, USA
  29. 29 Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
  30. 30 University Heart Center, Zurich, Switzerland
  31. 31 Heart Centre of Philadelphia, Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
  32. 32 Department of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
  33. 33 The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  34. 34 Institute of Sports Medicine and Science, Rome, Italy
  35. 35 Department of Cardiac Science, University of Padua Medical School, Padua, Italy
  36. 36 Department of Thoracic Sciences, University of Padua Medical School, Padua, Italy
  37. 37 Department of Vascular Sciences, University of Padua Medical School, Padua, Italy
  1. Correspondence to Jonathan A Drezner, Department of Family Medicine, Director, Center for Sports Cardiology, University of Washington, Seattle, WA 98195, USA; jdrezner{at}uw.edu

Abstract

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26–27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.

  • Athlete
  • Sudden cardiac arrest
  • Sudden cardiac death
  • Cardiovascular

https://doi.org/10.1136/bjsports-2016-097331

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    Footnotes

    • This statement has been endorsed by the following societies: American Medical Society for Sports Medicine (AMSSM), Austrian Society of Sports Medicine and Prevention, Brazilian Society of Cardiology - Department of Exercise and Rehabilitation (SBC - DERC), British Association for Sports and Exercise Medicine (BASEM), Canadian Academy of Sport and Exercise Medicine (CASEM), European College of Sports and Exercise Physicians (ECOSEP), European Society of Cardiology (ESC) Section of Sports Cardiology, Fédération Internationale de Football Association (FIFA), German Society of Sports Medicine and Prevention, International Olympic Committee (IOC), Norwegian Association of Sports Medicine and Physical Activity (NIMF), South African Sports Medicine Association (SASMA), Spanish Society of Cardiology (SEC) Sports Cardiology Group, Sports Doctors Australia, and the Swedish Society of Exercise and Sports Medicine (SFAIM). The American College of Cardiology (ACC) affirms the value of this document (ACC supports the general principles in the document and believes it is of general benefit to its membership).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.