International recommendations for electrocardiographic interpretation in athletes.
Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural, or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly over the last decade; pushed by a growing body of scientific data that both tests proposed criteria sets and establishes new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington, to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.
Cardiology Clinical Academic Group, St George's, University of London, UK.
Sanjay
S
Sharma
Department of Family Medicine, University of Washington, Seattle, WA, USA.
Jonathan A
JA
Drezner
Division of Cardiology, Massachusettes General Hospital, MA, USA.
Aaron
A
Baggish
Cardiology Clinical Academic Group, St George's, University of London, UK.
Michael
M
Papadakis
Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar.
Mathew G
MG
Wilson
Division of Cardiology, University of Washington, Seattle, WA, USA.
Jordan M
JM
Prutkin
Department of Cardiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
Andre
A
La Gerche
Department of Cardiovascular Diseases, Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, MN, USA.
Michael J
MJ
Ackerman
Department of Neuroscience and Physiology, Sahlgrenska University Hospital/Ostra Sahlgrenska Academy, Goteborg, Sweden.
Mats
M
Borjesson
Department of Pediatrics, University of Washington, Seattle, WA, USA.
Jack C
JC
Salerno
Department of Family Medicine, University of South Carolina, Greenville, SC, USA.
Irfan M
IM
Asif
Division of Cardiology, University of Washington, Seattle, WA, USA.
David S
DS
Owens
Division of Cardiology, University of North Carolina School of Medicine, NC, USA.
Eugene H
EH
Chung
Center of Cardiovascular Care in Athletics, Indiana University School of Medicine, IN, USA.
Michael S
MS
Emery
Department of Medicine, Stanford University, CA, USA.
Victor F
VF
Froelicher
Department of Cardiology, Arrhythmology Hasselt University, Hasselt, Belgium.|Department of Cardiology, Antwerp, Belgium.
Hein
H
Heidbuchel
Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar.
Carmen
C
Adamuz
Georgia Southern University, GA, USA.
Chad A
CA
Asplund
Division of Pediatric Cardiothoracic Surgery, University of California San Francisco School of Medicine, CA, USA.
Gordon
G
Cohen
Department of Family Medicine, University of Washington, Seattle, WA, USA.
Kimberly G
KG
Harmon
Advocate Heart Institute, Illinois, USA.
Joseph C
JC
Marek
Division of Pediatric Cardiology, Baylor College of Medicine, TX, USA.
Silvana
S
Molossi
University Institute of Sports Medicine, Paracelsus Medical University, Austria.
Josef
J
Niebauer
Department of Family Medicine, University of Washington, Seattle, WA, USA.
Hank F
HF
Pelto
Center for Inherited Cardiovascular Disease, Stanford University, CA, USA.
Marco V
MV
Perez
Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar.
Nathan R
NR
Riding
Pediatric Cardiology, Cleveland Clinic, OH, USA.
Tess
T
Saarel
University of Herzzentrum, Zurich, Switzerland.
Christian M
CM
Schmied
Heart Center of Philadelphia, Jefferson University Hospitals, PA, USA.
David M
DM
Shipon
Department of Cardiology, Hospital de Clinicas de Porte Allegre, Brazil.
Ricardo
R
Stein
The Children's Hospital of Philadelphia, PA, USA.
Victoria L
VL
Vetter
Institute of Sports Medicine and Science, Rome, Italy.
Antonio
A
Pelliccia
Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Italy.
Domenico
D
Corrado
D056352:Athletes; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D004562:Electrocardiography / Q000592:standards; D006321:Heart / Q000502:physiology* / Q000503:physiopathology; D006331:Heart Diseases / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans