title: Are the QRS duration and ST depression cut-points from the Seattle criteria too conservative?
abstract: BACKGROUND
  Screening athletes with ECGs is aimed at identifying "at-risk" individuals who may have a cardiac condition predisposing them to sudden cardiac death. The Seattle criteria highlight QRS duration greater than 140 ms and ST segment depression in two or more leads greater than 50 μV as two abnormal ECG patterns associated with sudden cardiac death.
  
  
  METHODS
  High school, college, and professional athletes underwent 12 lead ECGs as part of routine pre-participation physicals. Prevalence of prolonged QRS duration was measured using cut-points of 120, 125, 130, and 140 ms. ST segment depression was measured in all leads except leads III, aVR, and V1 with cut-points of 25 μV and 50 μV.
  
  
  RESULTS
  Between June 2010 and November 2013, 1595 participants including 297 (167 male, mean age 16.2) high school athletes, 1016 (541 male, mean age 18.8) college athletes, and 282 (mean age 26.6) male professional athletes underwent screening with an ECG. Only 3 athletes (0.2%) had a QRS duration greater than 125 ms. ST segment depression in two or more leads greater than 50 μV was uncommon (0.8%), while the prevalence of ST segment depression in two or more leads increased to 4.5% with a cut-point of 25 μV.
  
  
  CONCLUSIONS
  Changing the QRS duration cut-point to 125 ms would increase the sensitivity of the screening ECG, without a significant increase in false-positives. However, changing the ST segment depression cut-point to 25 μV would lead to a significant increase in false-positives and would therefore not be justified.
authors: Stanford University Medical School, Stanford University, Stanford, CA. Electronic address: dunntp@stanford.edu.
authors: Tim
authors: T
authors: Dunn
authors: Stanford University Medical School, Stanford University, Stanford, CA.
authors: Ramy
authors: R
authors: Abdelfattah
authors: Stanford University Medical School, Stanford University, Stanford, CA.
authors: Sonya
authors: S
authors: Aggarwal
authors: Stanford University Medical School, Stanford University, Stanford, CA.
authors: David
authors: D
authors: Pickham
authors: Cardea Ltd, Seattle, WA.
authors: David
authors: D
authors: Hadley
authors: Stanford University Medical School, Stanford University, Stanford, CA.
authors: Victor
authors: V
authors: Froelicher
mesh_terms: D000293:Adolescent; D056352:Athletes / Q000706:statistics & numerical data*; D002140:California / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine / Q000592:standards / Q000706:statistics & numerical data; D042241:Early Diagnosis; D004562:Electrocardiography / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006331:Heart Diseases / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D018580:Mandatory Testing / Q000592:standards / Q000706:statistics & numerical data; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014861:Washington
keywords: QRS duration; ST depression; Seattle criteria