Comparison of the prevalence of abnormal ECG findings representative of cardiomyopathy, pulmonary hypertension or primary electrical disturbance in 1078 elite athletes using the 2010 ESC criteria versus the Seattle Criteria
| Group 2 ECG abnormality ESC criteria 2010 | n (%) | Abnormal ECG Seattle Criteria 2013 | n (%) |
|---|---|---|---|
| Cardiomyopathy | 82 (7.6) | Cardiomyopathy | 46 (4.3) |
| LAD: −30° to −90° | 6 (0.6) | “ ” | 6 (0.6) |
| LAA: negative P wave V1/2 ≥1 mm deep and P duration >120 ms | 5 (0.5) | “ ” | 5 (0.5) |
| IVCD: any QRS duration >120 ms including RBBB and LBBB | 8 (0.7) | Any QRS ≥140 ms or complete LBBB | 1 (0.1) |
| T wave inversion: deep: ≥2 mm, ≥2 adjacent leads OR ‘minor’ in ≥2 leads | 69 (6.4) | >1 mm deep, ≥2 leads in V2−6, II, aVF, I and aVL | 25 (2.3) |
| ST segment depression: ≥0.5 mm deep in ≥2 leads | 2 (0.2) | “ ” | 2 (0.2) |
| Pathological Q waves: >4 mm deep in any lead except III, aVR | 2 (0.2) | >3 mm deep and/or >40 ms duration in ≥2 leads except III and aVR | 2 (0.2) |
| Pulmonary hypertension | 33 (3.1) | Pulmonary hypertension | 11 (1) |
| RVH: RV1+SV5/V6>10.5 mm | 24 (2.2) | ‘RVH pattern’: RV1+SV5>10.5 mm AND RAD >120° | 5 (0.5) |
| RAD: >110° | 15 (1.4) | – | |
| RAA: P wave >2.5 mm tall in II, III or aVF | 6 (0.6) | “ ” | 6 (0.6) |
| Primary electrical disturbance | 81 (7.5) | Primary electrical disturbance | 2 (0.2) |
| Isolated PR <120 ms Ventricular pre-excitation | 7 (0.6) 1 (0.1) | – “ ” | 1 (0.1) |
| LQTC: QTc >440 (M) or >460 (F) | 25 (2.3) | QTc ≥ 470 (M) or ≥ 480 (F) | 0 |
| SQTC: QTc < 360 ms | 46 (4.3) | QTc < 320 ms | 0 |
| Brugada type 1 ECG pattern | 0 | “ ” | 0 |
| Atrial tachyarrhythmias: SVT, atrial fibrillation/flutter | 0 | ||
| Couplets, triplets, NSVT, | 0 | ||
| ≥2 PVCs per 10 s tracing | 1 (0.1) | ||
| Abnormal ECG | 186 (17.3) | 48 (4.5) |
Differences between criteria are outlined in text, “ ” denotes no difference and — denotes removal of criteria. The sum of all abnormalities exceeds the total number of athletes with an abnormal ECG due to the presence of multiple ECG abnormalities in some.
LAD, left axis deviation; LAA, left atrial abnormality; IVCD, intraventricular conduction delay; RVH, right ventricular hypertrophy; RAD, right axis deviation; RAA, right atrial abnormality; LQTC, long corrected QT interval; SQTC, short corrected QT interval; SVT, supraventricular tachycardia; NSVT, non-sustained ventricular tachycardia.