title: Prevalence of abnormal electrocardiograms in Swiss elite athletes detected with modern screening criteria.
abstract: Sudden cardiac arrest in athletes is a rare but dramatic event. The value of a routine electrocardiogram (ECG) during preparticipation screening (PPS) remains controversial, partly because of the relatively high number of false positive findings. Our study aimed to evaluate the prevalence of abnormal ECGs in consecutive Swiss elite athletes, overall and with regard to different sports classes, using modern screening criteria.
  
  
  
  We analysed the 12-lead resting ECGs of high-level elite athletes (age ≥14 years) recorded at the Swiss Olympic Medical Centre Magglingen between 2013 and 2016 during routine PPS. The overall prevalence of abnormal ECGs was evaluated and compared in accordance with the original and revised Seattle criteria. Sports disciplines were categorised according to their static (estimated percentage of maximal voluntary contraction, I-III) and dynamic (estimated percentage of maximal oxygen uptake, A-C) components, and the prevalence of abnormal ECGs compared between sports classes by Fisher's exact test (with alpha set at 0.05).
  
  
  
  ECGs from 287 consecutive athletes were analysed (64.1% male; 99.7% Caucasian; median age 20.4 ± 4.9 years; median weekly training volume 17.7 ± 7.1 hours). Based on original Seattle criteria, eight (2.8%) ECGs were classified as abnormal: three T-wave inversion (TWI), one Q-wave duration >40 ms, two QRS left axis deviation, two Q-wave amplitude >3 mm. The use of the revised Seattle criteria reduced the number of abnormal ECGs to four (1.4%): three TWI, one Q-wave duration >40 ms. Further cardiological work-up revealed an underlying structural heart disease in only one of these four athletes (inferolateral TWI on ECG), consisting of very localised mid-wall fibrosis suggestive of former myocarditis. There was a significant difference in occurrence of abnormal ECGs between the different sports categories (p = 0.018). All four abnormal ECGs according to the revised Seattle criteria occurred in the high dynamic sport classes (IIC and IIIC); three out of the four were found in the high dynamic high static class (IIIC).
  
  
  
  In our cohort of high-level elite athletes, the prevalence of abnormal ECGs according to modern screening criteria was very low. All athletes with an abnormal ECG performed high dynamic sports. Less than one percent of our athletes had a new relevant cardiac diagnosis.
authors.affiliation: Department of Cardiology and Interdisciplinary Centre for Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Tilman
authors.initials: T
authors.lastname: Perrin
authors.affiliation: Department of Cardiology and Interdisciplinary Centre for Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Lukas Daniel
authors.initials: LD
authors.lastname: Trachsel
authors.affiliation: Department of Cardiology and Interdisciplinary Centre for Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Simon
authors.initials: S
authors.lastname: Schneiter
authors.affiliation: Clinic for Cardiology, Ospedale San Giovanni, Bellinzona, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Menafoglio
authors.affiliation: Swiss Federal Institute of Sports, Swiss Olympic Medical Centre, Magglingen, Switzerland.
authors.forename: Silvia
authors.initials: S
authors.lastname: Albrecht
authors.affiliation: Swiss Federal Institute of Sports, Swiss Olympic Medical Center, Magglingen, Switzerland.
authors.forename: Tony
authors.initials: T
authors.lastname: Pirrello
authors.affiliation: Department of Cardiology and Interdisciplinary Centre for Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Prisca
authors.initials: P
authors.lastname: Eser
authors.affiliation: Department of Cardiology and Interdisciplinary Centre for Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Laurent
authors.initials: L
authors.lastname: Roten
authors.affiliation: La Tour Sport Medicine, Swiss Olympic Medical Centre, Hôpital de La Tour, Geneva, Switzerland.
authors.forename: Boris
authors.initials: B
authors.lastname: Gojanovic
authors.affiliation: Department of Cardiology and Interdisciplinary Centre for Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Wilhelm
mesh_terms: D000293:Adolescent; D056352:Athletes / Q000706:statistics & numerical data*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005189:False Positive Reactions; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D015995:Prevalence; D013177:Sports / Q000502:physiology; D013557:Switzerland / Q000453:epidemiology; D055815:Young Adult