title: Variability in interpretation of the electrocardiogram in young athletes: an unrecognized obstacle for electrocardiogram-based screening protocols.
abstract: OBJECTIVE
  To assess in young athletes (i) the variability in the percentage of abnormal electrocardiograms (ECGs) using different criteria and (ii) the variability in ECG interpretation among cardiologists and sport physicians.
  
  
  RESULTS
  Electrocardiograms of 138 athletes were categorized by seven cardiologists according to the original European Society of Cardiology (ESC) criteria by Corrado (C), subsequently modified by Uberoi (U), Marek (M), and the Seattle criteria (S); seven sports physicians only used S criteria. The percentage of abnormal ECGs for each physician was calculated and the percentage of complete agreement was assessed. For cardiologists, the median percentage of abnormal ECGs was 14% [interquartile range (IQR) 12.5-20%] for C, 11% (IQR 9.5-12.5%) for U [not significant (NS) compared with C], 11% (IQR 10-13%) for M (NS compared with C), and 7% (IQR 5-8%) for S (P < 0.005 compared with C); complete agreement in interpretation was 64.5% for C, 76% for U (P < 0.05 compared with C), 74% for M (NS compared with C), and 84% for S (P < 0.0005 compared with C). Sport physicians classified a median of 7% (IQR 7-11%) of ECGs as abnormal by S (P = NS compared with cardiologists using S); complete agreement was 72% (P < 0.05 compared with cardiologists using S).
  
  
  CONCLUSIONS
  Seattle criteria reduced the number of abnormal ECGs in athletes and increased agreement in classification. However, variability in ECG interpretation by cardiologists and sport physicians remains high and is a limitation for ECG-based screening programs.
authors: Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium.
authors: Benjamin
authors: B
authors: Berte
authors: Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium Heart Center, Ghent University Hospital, Ghent, Belgium.
authors: Mattias
authors: M
authors: Duytschaever
authors: Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium.
authors: Juliana
authors: J
authors: Elices
authors: Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium.
authors: Vikas
authors: V
authors: Kataria
authors: Heart Center, Ghent University Hospital, Ghent, Belgium.
authors: Liesbeth
authors: L
authors: Timmers
authors: Heart Center, Ghent University Hospital, Ghent, Belgium.
authors: Frédéric
authors: F
authors: Van Heuverswyn
authors: Heart Center, Ghent University Hospital, Ghent, Belgium.
authors: Roland
authors: R
authors: Stroobandt
authors: Department of Rehabilitation and Sports Medicine, Sint-Jan Hospital Bruges, Bruges, Belgium.
authors: Jan
authors: J
authors: De Neve
authors: Department of Rehabilitation and Sports Medicine, Sint-Jan Hospital Bruges, Bruges, Belgium.
authors: Karel
authors: K
authors: Watteyne
authors: Department of Rehabilitation and Sports Medicine, Sint-Jan Hospital Bruges, Bruges, Belgium.
authors: Elke
authors: E
authors: Vandensteen
authors: Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium.
authors: Yves
authors: Y
authors: Vandekerckhove
authors: Department of Cardiology, Sint-Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium rene.tavernier@azsintjan.be.
authors: Rene
authors: R
authors: Tavernier
mesh_terms: D000293:Adolescent; D056352:Athletes / Q000706:statistics & numerical data*; D003627:Data Interpretation, Statistical; D004562:Electrocardiography; D005060:Europe; D006331:Heart Diseases / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008403:Mass Screening; D012955:Societies, Medical
keywords: Athletes; ECG; Screening