Abnormal ECG criteria in athletes. Any abnormal finding is considered training-unrelated and suggests the possibility of underlying pathological ciac disease, requiring further diagnostic investigation.
| Abnormal ECG finding | Definition |
|---|---|
| T-wave inversion | >1 mm in depth from baseline in two or more adjacent leads not including aVR or V1 |
| ST-segment depression | ≥1 mm in depth in two or more adjacent leads |
| Pathological Q waves | >3 mm in depth or >0.04 s in duration in two or more leads |
| Complete left bundle branch block | QRS >0.12 s, predominantly negative QRS complex in lead V1 (QS or rS), and upright monophasic R wave in leads I and V6 |
| Complete right bundle branch block | QRS >0.12 s, terminal R wave in lead V1 (rsR') and wide terminal S wave in leads I and V6 |
| Intraventricular conduction delay | Non-specific, QRS >0.12 s |
| Left atrial enlargement | Prolonged P wave duration of >0.12 s in leads I or II with negative portion of the P wave ≥1 mm in depth and ≥0.04 s in duration in lead V1 |
| Left axis deviation | −30° to 90° |
| Right atrial enlargement | High/pointed P wave ≥2.5 mm in leads II and III or V1 |
| Right ventricular hypertrophy | Right axis deviation ≥120°, tall R wave in V1+persistent precordial S waves (R–V1+S–V5>10.5 mm) |
| Mobitz type II 2° AV block | Intermittently non-conducted P waves not preceded by PR prolongation and not followed by PR shortening |
| 3° AV block | Complete heart block |
| Ventricular pre-excitation | PR interval <0.12 s with a δ wave (slurred upstroke in the QRS complex) |
| Long QT interval | QTc ≥0.47 s (99% men) QTc ≥0.48 s (99% women) (QTc ≥0.50 s (unequivocal LQTS) |
| Short QT interval | QTc ≤0.34 s |
| Brugada-like ECG pattern | High take-off and downsloping ST-segment elevation in V1−V3 |
| Epsilon wave | Small negative deflection just beyond the QRS in V1 or V2 |
| Profound sinus bradycia | <30 BPM or sinus pauses ≥3 s |
| Atrial tachyarrhythmias | Supraventricular tachycia, atrioventricular nodal re-entrant tachycia, atrial fibrillation, atrial flutter |
| Premature ventricular contractions | ≥2 per tracing |
| Ventricular arrhythmias | Couplets, triplets, non-sustained ventricular tachycia |
AV, atrioventricular; BPM, beats per minute; LQTS, long QT syndrome.