Skip to main content
SpringerLink
Log in

EKG-Diagnostik bei Leistungssportlern

Neue Aspekte

ECG diagnostics in competitive athletes

Current implications for preparticipation screening

  • Schwerpunkt
  • Published:
Herz Aims and scope Submit manuscript

Zusammenfassung

Der plötzliche Herztod eines jungen Leistungssportlers ist meist die tragische Erstmanifestation einer bis dahin unentdeckten strukturellen oder elektrischen Herzerkrankung. Charakteristische EKG-Veränderungen können Vorboten derartiger Risikokonstellationen sein, sind aber oft schwer von trainingsassoziierten Veränderungen vergleichbarer Morphologie auf dem Boden einer physiologischen kardialen Adaptation abzugrenzen. Fehlinterpretationen können demnach zu unnötigem Sportverbot, unberechtigter Sportfreigabe oder kostenintensiven Zusatzuntersuchungen mit oft ebenfalls schwer zu interpretierenden Befunden führen. Durch systematische Auswertungen großer Sportlerkollektive konnte in den letzten Jahren allerdings eine Reihe von EKG-Veränderungen wie isolierte QRS-Erhöhung, Sinusbradykardie, AV-Block Grad I, frühe Repolarisation oder inkompletter Rechtsschenkelblock als typischerweise trainingsassoziiert und somit nicht abklärungsbedürftig erkannt werden. Repolarisationsstörungen, Q-Zacken, komplette Blockbilder oder abnorme QT-Intervalle treten dagegen auch bei Leistungssportlern selten auf und sind primär abklärungsbedürftig. Dem EKG kommt damit eine Schlüsselposition in der Prävention des plötzlichen Herztodes zu. Die vorliegende Übersichtsarbeit stellt die kürzlich in Positionspapieren zusammengefassten, aktuell gültigen Kriterien zur Differenzialdiagnostik des Leistungssportler-EKG vor.

Abstract

In young competitive athletes sudden cardiac death frequently occurs as a tragic first manifestation of clinically inapparent underlying structural or electrical cardiac disorders. An increased risk may be reflected by typical electrocardiogram (ECG) alterations preceding symptoms but a correct interpretation is often challenging due to a high prevalence of training-related ECG alterations in competitive athletes mimicking such disorders. Misinterpretation may thus result in either unnecessary disqualification from competitive sports or continuation despite an increased risk or extensive diagnostic work-ups yielding additional equivocal findings. However, as observed in large athlete cohorts in recent years a variety of ECG alterations, such as isolated increased QRS voltage, early repolarization, sinus bradycardia, first degree AV block or incomplete right bundle branch block, represent common variants of ECGs of athletes reflecting physiological and training-related cardiac adaptations. These alterations do not usually require further diagnostic evaluation. In contrast, alterations such as repolarization abnormalities, complete bundle branch block, prolonged QT intervals or pathological Q waves, are strongly suggestive of underlying disorders and require further evaluation even in asymptomatic athletes. Thus, the ECG plays a pivotal role in the prevention of sudden cardiac death in competitive athletes. The present article summarizes current recommendations for the interpretation of athlete ECGs regarding the differentiation between physiological or pathological cardiac adaptation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Boldt LH, Haverkamp W (2009) Arrhythmogenic right ventricular cardiomyopathy: diagnosis and risk stratification. Herz 34:290–297

    Article  PubMed  Google Scholar 

  2. Cheitlin MD, MacGregor J (2009) Congenital anomalies of coronary arteries: role in the pathogenesis of sudden cardiac death. Herz 34:268–279

    Article  PubMed  Google Scholar 

  3. Corrado D, Migliore F, Basso C, Thiene G (2006) Exercise and the risk of sudden cardiac death. Herz 31:553–558

    Article  PubMed  Google Scholar 

  4. Kim JH, Malhotra R, Chiampas G et al (2012) Cardiac arrest during long-distance running races. N Engl J Med 366:130–140

    Article  PubMed  CAS  Google Scholar 

  5. Maron BJ, Doerer JJ, Haas TS et al (2009) Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006. Circulation 119:1085–1092

    Article  PubMed  Google Scholar 

  6. Schimpf R, Veltmann C, Wolpert C, Borggrefe M (2009) Channelopathies: Brugada syndrome, long QT syndrome, short QT syndrome, and CPVT. Herz 34:281–288

    Article  PubMed  Google Scholar 

  7. Seggewiss H, Blank C, Pfeiffer B, Rigopoulos A (2009) Hypertrophic cardiomyopathy as a cause of sudden death. Herz 34:305–314

    Article  PubMed  Google Scholar 

  8. Corrado D, Migliore F, Bevilacqua M et al (2009) Sudden cardiac death in athletes: can it be prevented by screening? Herz 34:259–266

    Article  PubMed  Google Scholar 

  9. Corrado D, Schmied C, Basso C et al (2011) Risk of sports: do we need a pre-participation screening for competitive and leisure athletes? Eur Heart J 32:934–944

    Article  PubMed  Google Scholar 

  10. Maron BJ, Haas TS, Doerer JJ et al (2009) Comparison of U.S. and Italian experiences with sudden cardiac deaths in young competitive athletes and implications for preparticipation screening strategies. Am J Cardiol 104:276–280

    Article  PubMed  Google Scholar 

  11. Steinvil A, Chundadze T, Zeltser D et al (2011) Mandatory electrocardiographic screening of athletes to reduce their risk for sudden death proven fact or wishful thinking? J Am Coll Cardiol 57:1291–1296

    Article  PubMed  Google Scholar 

  12. Wheeler MT, Heidenreich PA, Froelicher VF et al (2010) Cost-effectiveness of preparticipation screening for prevention of sudden cardiac death in young athletes. Ann Intern Med 152:276–286

    PubMed  Google Scholar 

  13. Baggish AL, Hutter AM Jr, Wang F et al (2010) Cardiovascular screening in college athletes with and without electrocardiography: A cross-sectional study. Ann Intern Med 152:269–275

    PubMed  Google Scholar 

  14. Beckner GL, Winsor T (1954) Cardiovascular adaptations to prolonged physical effort. Circulation 9:835–846

    Article  PubMed  CAS  Google Scholar 

  15. Hanne-Paparo N, Wendkos MH, Brunner D (1971) T wave abnormalities in the electrocardiograms of top-ranking athletes without demonstrable organic heart disease. Am Heart J 81:743–747

    Article  PubMed  CAS  Google Scholar 

  16. Zehender M, Meinertz T, Keul J, Just H (1990) ECG variants and cardiac arrhythmias in athletes: clinical relevance and prognostic importance. Am Heart J 119:1378–1391

    Article  PubMed  CAS  Google Scholar 

  17. Pelliccia A, Maron BJ, Culasso F et al (2000) Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 102:278–284

    Article  PubMed  CAS  Google Scholar 

  18. Sharma S, Whyte G, Elliott P et al (1999) Electrocardiographic changes in 1000 highly trained junior elite athletes. Br J Sports Med 33:319–324

    Article  PubMed  CAS  Google Scholar 

  19. Pelliccia A, Di Paolo FM, Quattrini FM et al (2008) Outcomes in athletes with marked ECG repolarization abnormalities. N Engl J Med 358:152–161

    Article  PubMed  CAS  Google Scholar 

  20. Corrado D, Pelliccia A, Heidbuchel H et al (2010) Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J 31:243–259

    Article  PubMed  Google Scholar 

  21. Uberoi A, Stein R, Perez MV et al (2011) Interpretation of the electrocardiogram of young athletes. Circulation 124:746–757

    Article  PubMed  Google Scholar 

  22. Dickhuth HH, Rocker K, Mayer F et al (2004) Endurance training and cardial adaptation (athlete’s heart). Herz 29:373–380

    Article  PubMed  Google Scholar 

  23. Stein R, Medeiros CM, Rosito GA et al (2002) Intrinsic sinus and atrioventricular node electrophysiologic adaptations in endurance athletes. J Am Coll Cardiol 39:1033–1038

    Article  PubMed  Google Scholar 

  24. Meytes I, Kaplinsky E, Yahini JH et al (1975) Wenckebach A-V block: a frequent feature following heavy physical training. Am Heart J 90:426–430

    Article  PubMed  CAS  Google Scholar 

  25. Heidbuchel H, Panhuyzen-Goedkoop N, Corrado D et al (2006) Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions Part I: Supraventricular arrhythmias and pacemakers. Eur J Cardiovasc Prev Rehabil 13:475–484

    Article  PubMed  Google Scholar 

  26. Biffi A, Maron BJ, Culasso F et al (2011) Patterns of ventricular tachyarrhythmias associated with training, deconditioning and retraining in elite athletes without cardiovascular abnormalities. Am J Cardiol 107:697–703

    Article  PubMed  Google Scholar 

  27. Mont L, Elosua R, Brugada J (2009) Endurance sport practice as a risk factor for atrial fibrillation and atrial flutter. Europace 11:11–17

    Article  PubMed  Google Scholar 

  28. Heidbuchel H, Corrado D, Biffi A et al (2006) Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part II: ventricular arrhythmias, channelopathies and implantable defibrillators. Eur J Cardiovasc Prev Rehabil 13:676–686

    Article  PubMed  Google Scholar 

  29. Mason JW, Ramseth DJ, Chanter DO et al (2007) Electrocardiographic reference ranges derived from 79,743 ambulatory subjects. J Electrocardiol 40:228–234

    Article  PubMed  Google Scholar 

  30. Pelliccia A, Maron BJ, Di Paolo FM et al (2005) Prevalence and clinical significance of left atrial remodeling in competitive athletes. J Am Coll Cardiol 46:690–696

    Article  PubMed  Google Scholar 

  31. Hiss RG, Lamb LE (1962) Electrocardiographic findings in 122,043 individuals. Circulation 25:947–961

    Article  PubMed  CAS  Google Scholar 

  32. Pelliccia A, Zipes DP, Maron BJ (2008) Bethesda Conference #36 and the European Society of Cardiology Consensus Recommendations revisited a comparison of U.S. and European criteria for eligibility and disqualification of competitive athletes with cardiovascular abnormalities. J Am Coll Cardiol 52:1990–1996

    Article  PubMed  Google Scholar 

  33. Pressler A, Haller B, Scherr J et al (2011) Association of body composition and left ventricular dimensions in elite athletes. Eur J Cardiovasc Prev Rehabil [Epub ahead of print]

  34. Hsieh BP, Pham MX, Froelicher VF (2005) Prognostic value of electrocardiographic criteria for left ventricular hypertrophy. Am Heart J 150:161–167

    Article  PubMed  Google Scholar 

  35. Langdeau JB, Blier L, Turcotte H et al (2001) Electrocardiographic findings in athletes: the prevalence of left ventricular hypertrophy and conduction defects. Can J Cardiol 17:655–659

    PubMed  CAS  Google Scholar 

  36. Kim JH, Noseworthy PA, McCarty D et al (2011) Significance of electrocardiographic right bundle branch block in trained athletes. Am J Cardiol 107:1083–1089

    Article  PubMed  Google Scholar 

  37. La Gerche A, Burns AT, Mooney DJ et al (2011) Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur Heart J 33(8):998–1006

    Google Scholar 

  38. Benito B, Gay-Jordi G, Serrano-Mollar A et al (2011) Cardiac arrhythmogenic remodeling in a rat model of long-term intensive exercise training. Circulation 123:13–22

    Article  PubMed  Google Scholar 

  39. Wilson M, O’Hanlon R, Prasad S et al (2011) Diverse patterns of myocardial fibrosis in lifelong, veteran endurance athletes. J Appl Physiol 110:1622–1626

    Article  PubMed  CAS  Google Scholar 

  40. Chevallier S, Forclaz A, Tenkorang J et al (2011) New electrocardiographic criteria for discriminating between Brugada types 2 and 3 patterns and incomplete right bundle branch block. J Am Coll Cardiol 58:2290–2298

    Article  PubMed  Google Scholar 

  41. Aro AL, Anttonen O, Tikkanen JT et al (2011) Intraventricular conduction delay in a standard 12-lead electrocardiogram as a predictor of mortality in the general population. Circ Arrhythm Electrophysiol 4:704–710

    Article  PubMed  Google Scholar 

  42. Bongioanni S, Bianchi F, Migliardi A et al (2007) Relation of QRS duration to mortality in a community-based cohort with hypertrophic cardiomyopathy. Am J Cardiol 100:503–506

    Article  PubMed  Google Scholar 

  43. Marcus FI, McKenna WJ, Sherrill D et al (2010) Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task Force Criteria. Eur Heart J 31:806–814

    Article  PubMed  Google Scholar 

  44. Haissaguerre M, Derval N, Sacher F et al (2008) Sudden cardiac arrest associated with early repolarization. N Engl J Med 358:2016–2023

    Article  PubMed  CAS  Google Scholar 

  45. Tikkanen JT, Anttonen O, Junttila MJ et al (2009) Long-term outcome associated with early repolarization on electrocardiography. N Engl J Med 361:2529–2537

    Article  PubMed  CAS  Google Scholar 

  46. Haruta D, Matsuo K, Tsuneto A et al (2011) Incidence and prognostic value of early repolarization pattern in the 12-lead electrocardiogram. Circulation 123:2931–2937

    Article  PubMed  Google Scholar 

  47. Perez MV, Uberoi A, Jain NA et al (2012) The prognostic value of early repolarization with ST-segment elevation in African Americans. Heart Rhythm 9:558–565

    Article  PubMed  Google Scholar 

  48. Uberoi A, Jain NA, Perez M et al (2011) Early repolarization in an ambulatory clinical population. Circulation 124:2208–2214

    Article  PubMed  Google Scholar 

  49. Noseworthy PA, Tikkanen JT, Porthan K et al (2011) The early repolarization pattern in the general population: clinical correlates and heritability. J Am Coll Cardiol 57:2284–2289

    Article  PubMed  Google Scholar 

  50. Leo T, Uberoi A, Jain NA et al (2011) The impact of ST elevation on athletic screening. Clin J Sport Med 21:433–440

    Article  PubMed  Google Scholar 

  51. Noseworthy PA, Weiner R, Kim J et al (2011) Early repolarization pattern in competitive athletes: clinical correlates and the effects of exercise training. Circ Arrhythm Electrophysiol 4:432–440

    Article  PubMed  Google Scholar 

  52. Rosso R, Glikson E, Belhassen B et al (2012) Distinguishing „benign“ from „malignant early repolarization“: the value of the ST-segment morphology. Heart Rhythm 9:225–229

    Article  PubMed  Google Scholar 

  53. Tikkanen JT, Junttila MJ, Anttonen O et al (2011) Early repolarization: electrocardiographic phenotypes associated with favorable long-term outcome. Circulation 123:2666–2673

    Article  PubMed  Google Scholar 

  54. Cappato R, Furlanello F, Giovinazzo V et al (2010) J wave, QRS slurring, and ST elevation in athletes with cardiac arrest in the absence of heart disease: marker of risk or innocent bystander? Circ Arrhythm Electrophysiol 3:305–311

    Article  PubMed  Google Scholar 

  55. Junttila MJ, Gonzalez M, Lizotte E et al (2008) Induced Brugada-type electrocardiogram, a sign for imminent malignant arrhythmias. Circulation 117:1890–1893

    Article  PubMed  Google Scholar 

  56. Papadakis M, Basavarajaiah S, Rawlins J et al (2009) Prevalence and significance of T-wave inversions in predominantly Caucasian adolescent athletes. Eur Heart J 30:1728–1735

    Article  PubMed  Google Scholar 

  57. Papadakis M, Carre F, Kervio G et al (2011) The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin. Eur Heart J 32:2304–2313

    Article  PubMed  Google Scholar 

  58. Pressler A, Scherr J, Wolfarth B, Halle M (2009) T-wave inversions in elite athletes: the best predictors have yet to be determined. Eur Heart J 30:2947–2948

    Article  PubMed  Google Scholar 

  59. Pelliccia A, Dipaolo FM (2011) Athletes with abnormal repolarization pattern and structurally normal heart can participate in competitive sport a lifelong experience. J Am Coll Cardiol 58:883–884

    Article  PubMed  Google Scholar 

  60. Basavarajaiah S, Wilson M, Whyte G et al (2007) Prevalence and significance of an isolated long QT interval in elite athletes. Eur Heart J 28:2944–2949

    Article  PubMed  Google Scholar 

  61. Cerrone M, Priori SG (2011) Genetics of sudden death: focus on inherited channelopathies. Eur Heart J 32:2109–2118

    Article  PubMed  Google Scholar 

  62. Pressler A, Vogel A, Scherr J et al (2012) Applying the „Viskin test“: QT interval in response to standing in elite athletes. Int J Cardiol 154:93–94

    Article  PubMed  Google Scholar 

  63. Viskin S, Postema PG, Bhuiyan ZA et al (2010) The response of the QT interval to the brief tachycardia provoked by standing: a bedside test for diagnosing long QT syndrome. J Am Coll Cardiol 55:1955–1961

    Article  PubMed  Google Scholar 

  64. Giustetto C, Schimpf R, Mazzanti A et al (2011) Long-term follow-up of patients with short QT syndrome. J Am Coll Cardiol 58:587–595

    Article  PubMed  Google Scholar 

  65. Di Paolo FM, Schmied C, Zerguini YA et al (2012) The athlete’s heart in adolescent Africans: an electrocardiographic and echocardiographic study. J Am Coll Cardiol 59:1029–1036

    Article  Google Scholar 

  66. Rawlins J, Carre F, Kervio G et al (2010) Ethnic differences in physiological cardiac adaptation to intense physical exercise in highly trained female athletes. Circulation 121:1078–1085

    Article  PubMed  CAS  Google Scholar 

  67. Magalski A, Maron BJ, Main ML et al (2008) Relation of race to electrocardiographic patterns in elite American football players. J Am Coll Cardiol 51:2250–2255

    Article  PubMed  Google Scholar 

  68. Wilson MG, Chatard JC, Carre F et al (2012) Prevalence of electrocardiographic abnormalities in West-Asian and African male athletes. Br J Sports Med 46:341–347

    Article  PubMed  CAS  Google Scholar 

  69. Basavarajaiah S, Boraita A, Whyte G et al (2008) Ethnic differences in left ventricular remodeling in highly-trained athletes relevance to differentiating physiologic left ventricular hypertrophy from hypertrophic cardiomyopathy. J Am Coll Cardiol 51:2256–2262

    Article  PubMed  Google Scholar 

  70. Sedehi D, Ashley EA (2010) Defining the limits of athlete’s heart: implications for screening in diverse populations. Circulation 121:1066–1068

    Article  PubMed  Google Scholar 

  71. Migliore F, Zorzi A, Michieli P et al (2012) Prevalence of cardiomyopathy in Italian asymptomatic children with electrocardiographic T-wave inversion at preparticipation screening. Circulation 125:529–538

    Article  PubMed  Google Scholar 

  72. Gademan MG, Uberoi A, Le VV et al (2012) The effect of sport on computerized electrocardiogram measurements in college athletes. Eur J Prev Cardiol 19:126–138

    Article  PubMed  Google Scholar 

  73. Pelliccia A, Maron BJ, Culasso F et al (1996) Athlete’s heart in women. Echocardiographic characterization of highly trained elite female athletes. JAMA 276:211–215

    Article  PubMed  CAS  Google Scholar 

  74. Borjesson M, Urhausen A, Kouidi E et al (2011) Cardiovascular evaluation of middle-aged/senior individuals engaged in leisure-time sport activities: position stand from the sections of exercise physiology and sports cardiology of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 18:446–458

    Article  PubMed  Google Scholar 

  75. Cuneo A, Oeckinghaus R, Tebbe U (2011) Leisure sport activity as a trigger for acute coronary events in men without known coronary artery disease: a single-center case study. Herz 36:637–642

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seinen Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, Technische Universität, Georg-Brauchle-Ring 56 (Campus C), 80992, München, Deutschland

    A. Preßler & M. Halle

Authors
  1. A. Preßler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Halle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Preßler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Preßler, A., Halle, M. EKG-Diagnostik bei Leistungssportlern. Herz 37, 474–485 (2012). https://doi.org/10.1007/s00059-012-3636-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-012-3636-7

Schlüsselwörter

Keywords

Search

Navigation