Electrocardiogram of the athlete: An analysis of 289 professional football players

doi:10.1016/0002-9149(84)90090-0

The American Journal of Cardiology

Volume 53, Issue 9, 1 May 1984, Pages 1339-1343

https://doi.org/10.1016/0002-9149(84)90090-0 Get rights and content

Abstract

The electrocardiogram (EGG) of athletes reflects physiologic cardiovascular adaptations that occur in well-conditioned individuals. To more clearly define electrocardiographic changes seen in predominantly power-trained athletes, the ECGs of 289 apparently healthy professional football players were analyzed in detail. The players, aged 21 to 35 years, one-third of whom were black, had a mean body surface area of 2.24 m², a mean heart rate at rest of 56 ± 9 beats/min (with 77% (223) having a rate of less than 60 beats/min), and a mean P axis of 30 ± 25 °. A wide QRS-T angle (>60 °) was present in 14% (41 players) of the group. The mean PR interval was 0.18 ± 0.02 second (>0.21 in 9% [26 players]). Although two-thirds of the players had a QRS duration of 0.10 second, only 1 had right bundle branch block and none had left bundle branch block. The sum of S in lead V₁ plus R in lead V₅ averaged 37 ± 9 mm, with 35% (101 players) demonstrating voltage criteria for left ventricular hypertrophy. The S + R value varied inversely with weight (r = −0.27, p < 0.002). The maximum T height in any lead had a mean of 8.6 ± 3 mm, with 22% (64 players) having a T height ≥11 mm. U waves were universally present. ST-T changes mimicking ischemia were noted in 39 of 289 players (13%), 22 (58%) of whom were black (p < 0.001). The maximal J-point elevation in any lead averaged 1.9 ± 0.9 mm. These findings confirm that the ECGs of power-trained athletes show changes similar to those of endurance-trained athletes. These changes most likely reflect the increased vagal tone and ventricular mass observed in conditioned athletes. Large body size masks the voltage changes expected with increased left ventricular mass. Ischemic-like ST-T-wave deviations were found predominantly in black athletes.

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High performance athlete's heart: Results of a cross-sectional survey conducted in Bobo-Dioulasso, Burkina Faso
2019, Annales de Cardiologie et d'Angeiologie
Décrire les caractéristiques cliniques, électrocardiographiques et échocardio-graphiques du cœur d’athlète.
Il s’est agi d’une étude transversale réalisée d’août 2015 à février 2016 dans la ville de Bobo-Dioulasso au Burkina Faso. Des sportifs de haut niveau d’entraînement (au moins 8 heures d’entraînement hebdomadaire, depuis plus de six mois quel que soit le type de sport) ont bénéficié : d’un examen clinique, d’une électrocardiographie et d’une échographie cardiaque de repos pour rechercher des modifications cardiaques électriques, morphologiques et fonctionnelles.
Les 192 sportifs ayant un cœur d’athlète inclus avaient un âge médian de 24 ans (IIQ : 21–27). La médiane de l’ancienneté de la pratique du sport de haut niveau était de 6 ans (IIQ : 4–8) et celle des séances d’entraînement hebdomadaire de 10 heures (IIQ : 10–10). La consommation de tabac, alcool, thé/café, médicaments et/ou boissons énergisantes étaient rapportée respectivement chez 4,2 %, 7,3 %, 99 %, 53,4 %. Un antécédent de malaises d’effort était rapporté par 4,7 des athlètes. Les modifications électriques étaient présentes chez 92,1 %. La bradycardie sinusale était l’anomalie la plus fréquente (75,0 % des cas). La prévalence de la dilatation de l’oreillette gauche et celle du ventricule gauche étaient respectivement de 72,4 et 22,4 %. Celle de l’hypertrophie du ventricule gauche était de 9,0 %.
Chez l’athlète de haut niveau d’entraînement les prévalences des modifications électriques, morphologiques et fonctionnelles étaient élevées. Celles-ci nécessitent d’être connus par les praticiens afin de les différencier de la pathologie cardiaque.
To describe the clinical, electrocardiographic and echocardiographic features of the athlete's heart.
This was a cross-sectional study conducted from August 2015 to February 2016 in the city of Bobo-Dioulasso in Burkina Faso. Athletes of high level of training (at least 8 hours of weekly training, for more than six months regardless of the type of sport) have benefited from: a clinical examination, an electrocardiography and a cardiac ultrasound rest to look for electrical, morphological and functional cardiac changes.
The 192 athletes with an athlete heart included had a median age of 24 years (IQI: 21–27). The median seniority in high performance sport was 6 years (IQI: 4–8) and 10 hours weekly training sessions (IQI: 10–10). The consumption of tobacco, alcohol, tea/coffee, medicines and/or energy drinks was reported respectively in 4.2%, 7.3%, 99.0%, 53.4%. A history of exertional discomfort was reported by 4.7 athletes. Electrical modifications were present in 92.1%. Sinus bradycardia was the most common abnormality (75.0% of cases). The prevalence of left atrium dilatation and left ventricular dilation was 72.4 and 22.4%, respectively. That of left ventricular hypertrophy was 9.0%.
In the high-performance athlete, the prevalence of electrical, morphological and functional changes was high. These need to be known by practitioners to differentiate them from cardiac pathology.
Sudden Cardiac Deaths in Athletes, Including Commotio Cordis
2018, Cardiac Electrophysiology: From Cell to Bedside: Seventh Edition
Prevalence and significance of isolated T wave inversion in 1755 consecutive American collegiate athletes
2015, Journal of Electrocardiology
Citation Excerpt :
Multiple factors that likely influence TWI vary among studies. These include different sporting disciplines, level of fitness at the time of preparticipation evaluation, duration of athletic participation, gender, ethnicity and age [5,12–15,17–20,23,26,28–30,32,39,40]. Further modification of ECG interpretation criteria based on these characteristics, has the potential to decrease false positive rates and improve the cost effectiveness of pre-participation screening with ECG [41].
We evaluated the prevalence of isolated T-wave inversions (TWI) in American athletes using contemporary ECG criteria. Ethnic and gender disparities including the association of isolated TWI with underlying abnormal cardiac structure are evaluated.
From 2004 to 2014, 1755 collegiate athletes at a single American university underwent prospective collection of medical history, physical examination, 12-lead ECG, and 2-dimensional echocardiography. ECG analysis was performed to evaluate for isolated TWI as per contemporary ECG criteria.
The overall prevalence of isolated TWI is 1.3%. Ethnic and gender disparities are not observed in American athletes (black vs. white: 1.7% vs. 1.1%; p=0.41) (women vs. men: 1.5% vs. 1.1; p=0.52). No association was found with underlying cardiomyopathy.
A lower prevalence of isolated TWI in American athletes than previously reported. Isolated TWI was not associated with an abnormal echocardiogram. No ethnic or gender disparity is seen in American college athletes.
Sudden Cardiac Deaths in Athletes, Including Commotio Cordis
2014, Cardiac Electrophysiology: From Cell to Bedside: Sixth Edition
Bradyarrhythmias: How slow is too slow in the athlete?
2013, Cardiac Electrophysiology Clinics
Citation Excerpt :
These changes are more commonly described in endurance athletes, as long-distance runners and cyclists (cyclic sports), not occurring frequently in power-training athletes. However, Balady and colleagues38 have found similar results analyzing the ECGs of 289 professional football players (acyclic sport). The mean resting heart rate was 56 beats per minute (bpm), with 77% of the American football players having less than 60 bpm.
Risk of sudden death among young individuals with J waves and early repolarization: Putting the evidence into perspective
2011, Heart Rhythm
Citation Excerpt :
All things considered, the only reasonable clinical implication of the population studies is that patients with J waves should reduce their long-term risk for myocardial infarction by treating modifiable risk factors for coronary artery disease in accordance with practice guidelines for the population in general. The reported prevalence of early repolarization (mainly ST-segment elevation) reported for athletes varies widely across studies.7–11,57 One recent study found that early repolarization (manifesting as J waves or R-wave slurring) was four times more prevalent among athletes with a history of cardiac arrest than among healthy athletes.36
The presence of J waves and ST-segment elevation on the electrocardiogram (ECG), jointly termed “the early repolarization pattern,” has traditionally been considered a marker of “good health.” However, recent case control series and long-term population studies have established a statistically significant association between this ECG pattern and an increased risk for arrhythmic death. This finding has raised concern among physicians, who now are asked to estimate the “arrhythmic risk” following the incidental discovery of J waves on routine ECG. Therefore, we review the literature linking early repolarization with arrhythmic risk to place this “fear of J waves” in the right perspective. We found five case control studies (involving 331 patients with idiopathic ventricular fibrillation [VF] and 8,649 controls). All of these studies showed that J waves, particularly of large amplitude and recorded in multiple leads, are more prevalent among patients with idiopathic VF. We also found three large population studies (involving >17,000 individuals) looking at the prognostic value of early repolarization. Two of these studies showed that the presence of J waves >2 mm in amplitude in asymptomatic adults is associated with a threefold increased of arrhythmic death during very long-term follow-up. Individuals with J waves do have some degree of increased dispersion of repolarization that places them at increased risk for arrhythmic death, but only in the presence of additional proarrhythmic factors or triggers. A sensible approach for the asymptomatic patient with J waves is proposed.

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Miscellaneous topicElectrocardiogram of the athlete: An analysis of 289 professional football players

Abstract

Am J Cardiol

Am J Cardiol

Ann Intern Med

Circulation

Ann Med Int Fennae

Br Heart J

The athlete's heart syndrome. A new perspective

Ann NY Acad Sci

The electrocardiogram of athletes. Comparison with untrained subjects

Br Heart J

The athlete's heart

Adv Intern Med