J wave, QRS slurring, and ST elevation in athletes with cardiac arrest in the absence of heart disease: marker of risk or innocent bystander?
BACKGROUND
QRS-ST changes in the inferior and lateral ECG leads are frequently observed in athletes. Recent studies have suggested a potential arrhythmogenic significance of these findings in the general population. The aim of our study was to investigate whether QRS-ST changes are markers of cardiac arrest (CA) of unexplained cause or sudden death in athletes.


RESULTS
In 21 athletes (mean age, 27 years; 5 women) with cardiac arrest or sudden death, the ECG recorded before or immediately after the clinical event was compared with the ECG of 365 healthy athletes eligible for competitive sport activity. We measured the height of the J wave and ST elevation and searched for the presence of QRS slurring in the terminal portion of QRS. QRS slurring in any lead was present in 28.6% of cases and in 7.6% of control athletes (P=0.006). A J wave and/or QRS slurring without ST elevation in the inferior (II, III, and aVF) and lateral leads (V(4) to V(6)) were more frequently recorded in cases than in control athletes (28.6% versus 7.9%, P=0.007). Among those with cardiac arrest, arrhythmia recurrences did not differ between the subgroups with and without J wave or QRS slurring during a median 36-month follow-up of sport discontinuation.


CONCLUSIONS
J wave and/or QRS slurring was found more frequently among athletes with cardiac arrest/sudden death than in control athletes. Nevertheless, the presence of this ECG pattern appears not to confer a higher risk for recurrent malignant ventricular arrhythmias.
Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, Milan, Italy. riccardo.cappato@grupposandonato.it
Riccardo
R
Cappato
Francesco
F
Furlanello
Valerio
V
Giovinazzo
Tommaso
T
Infusino
Pierpaolo
P
Lupo
Mario
M
Pittalis
Sara
S
Foresti
Guido
G
De Ambroggi
Hussam
H
Ali
Elisabetta
E
Bianco
Roberto
R
Riccamboni
Gianfranco
G
Butera
Cristian
C
Ricci
Marco
M
Ranucci
Antonio
A
Pelliccia
Luigi
L
De Ambroggi
D000200:Action Potentials; D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D056352:Athletes; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D007558:Italy; D008297:Male; D016017:Odds Ratio; D005082:Physical Exertion; D057216:Propensity Score; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult