title: Comparison of three ECG criteria for athlete pre-participation screening.
abstract: Controversy regarding adding the ECG to the evaluation of young athletes centers on the implications of false positives. Several guidelines have been published with recommendations for criteria to distinguish between ECG manifestations of training and markers of risk for cardiovascular (CV) sudden death. With an athlete dataset negative of any CV related abnormalities on follow-up, we applied three athlete screening criteria to identify the one with the lowest rate of abnormal variants.
  
  
  METHODS
  High school, college, and professional athletes underwent 12L ECGs as part of routine physicals. All ECGs were recorded and processed using CardeaScreen (Seattle, WA). The European (2010), Stanford (2011), and Seattle criteria (2013) were applied.
  
  
  RESULTS
  From March 2011 to February 2013 1417 ECGs were collected. Mean age was 20±4years (14-35years), 36% female, 38.5% non-white (307 high school, 836 college and 284 professional). Rate of abnormal variants differed by criteria, predominately due to variation in interval thresholds for QT interval and QRS duration. There was a four-fold difference in abnormal variants between European and Seattle criteria (26% v 6%).
  
  
  CONCLUSIONS
  The Seattle criterion was the most conservative resulting in 78% fewer abnormal variants than the European criteria. Variation was most evident with thresholds for QT prolongation, short QT interval, and intraventricular conduction delay. Continued research is needed to further understand normal training related adaptations and to improve modern ECG screening criteria for athletes.
authors.affiliation: Stanford Health Care, Stanford, CA, USA. Electronic address: david.pickham@ucsf.edu.
authors.forename: David
authors.initials: D
authors.lastname: Pickham
authors.affiliation: Stanford Health Care, Stanford, CA, USA.
authors.forename: Shirin
authors.initials: S
authors.lastname: Zarafshar
authors.affiliation: Gunn High School, Palo Alto, CA, USA.
authors.forename: Divya
authors.initials: D
authors.lastname: Sani
authors.affiliation: Gunn High School, Palo Alto, CA, USA.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Kumar
authors.affiliation: VA Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Froelicher
mesh_terms: D000328:Adult; D000465:Algorithms; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D010808:Physical Examination / Q000379:methods; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013177:Sports; D013178:Sports Medicine / Q000379:methods; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Athlete screening; Electrocardiogram criteria; Pre-participation screening; Seattle criteria