Abnormal ECG findings in athletes
| Abnormal ECG finding | Definition |
|---|---|
| T-wave inversion | >1 mm in depth in two or more leads V2–V6, II and aVF, or I and aVL (excludes III, aVR and V1) |
| ST segment depression | ≥0.5 mm in depth in two or more leads |
| Pathologic Q waves | >3 mm in depth or >40 ms in duration in two or more leads (except for III and aVR) |
| Complete left bundle branch block | QRS ≥120 ms, predominantly negative QRS complex in lead V1 (QS or rS), and upright monophasic R wave in leads I and V6 |
| Intraventricular conduction delay | Any QRS duration ≥140 ms |
| Left axis deviation | −30° to −90° |
| Left atrial enlargement | Prolonged P wave duration of >120 ms in leads I or II with negative portion of the P wave ≥1 mm in depth and ≥40 ms in duration in lead V1 |
| Right ventricular hypertrophy pattern | R−V1+S−V5>10.5 mm AND right axis deviation >120° |
| Ventricular pre-excitation | PR interval <120 ms with a delta wave (slurred upstroke in the QRS complex) and wide QRS (>120 ms) |
| Long QT interval* | QTc≥470 ms (male) QTc≥480 ms (female) QTc≥500 ms (marked QT prolongation) |
| Short QT interval* | QTc≤320 ms |
| Brugada-like ECG pattern | High take-off and downsloping ST segment elevation followed by a negative T wave in ≥2 leads in V1–V3 |
| Profound sinus bradycardia | <30 BPM or sinus pauses ≥ 3 s |
| Atrial tachyarrhythmias | Supraventricular tachycardia, atrial-fibrillation, atrial-flutter |
| Premature ventricular contractions | ≥2 PVCs per 10 s tracing |
| Ventricular arrhythmias | Couplets, triplets and non-sustained ventricular tachycardia |
Note: These ECG findings are unrelated to regular training or expected physiological adaptation to exercise, may suggest the presence of pathological cardiovascular disease, and require further diagnostic evaluation.
*The QT interval corrected for heart rate is ideally measured with heart rates of 60–90 bpm. Consider repeating the ECG after mild aerobic activity for borderline or abnormal QTc values with a heart rate <50 bpm.