Skip to main content
SpringerLink
Log in

Electrocardiographic Changes in the Athlete’s Heart

  • Chapter
  • First Online:
Sport-related sudden cardiac death

  • 529 Accesses

Abstract

Despite the impressive progress of imaging techniques in cardiology, able to diagnose even minimal and subtle heart diseases, the ECG remains a valuable diagnostic tool for the sports physician working at the “first level” of sports medicine, deciding about sports eligibility (mandatory by law in Italy). The task is even more complex, as sports physicians screen a population of (theoretically) healthy athletes for some kind of very rare heart diseases, burdened by the risks of unwanted side effects, and above all sport-related sudden death (SD). Extensive evidence proved that many heart diseases with high risk of sports-related SD often show ECG abnormalities that can bring to suspect or directly diagnose their presence. These changes can sometime be misinterpreted at a superficial reading of the athlete’s ECG. It is enough thinking, for importance and frequency, about hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and the channelopathies (long and short QT syndromes, etc.). This chapter will focus on the main changes on the ECG induced by years of regular training in athletes. The ECG changes related to specific heart diseases will be addressed in the proper chapters.

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

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Venerando A, Rulli V. Frequency, morphology and meaning of the electrocardiographic anomalies found in Olympic marathon runners and walkers. J Sports Med Phys Fitness. 1964;50:135–41.

    Google Scholar 

  2. Plas F. Guide de Cardiologie du Sport. Paris: JB Bailliere; 1976.

    Google Scholar 

  3. Zeppilli P. The athlete’s heart. Pract Cardiol. 1988;14(8):61.

    Google Scholar 

  4. Drezner JA, Sharma S, Baggish A, Papadakis M, Wilson MG, Prutkin JM, et al. International criteria for electrocardiographic interpretation in athletes: consensus statement. Br J Sports Med. 2017;51:704–31.

    Article  Google Scholar 

  5. Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296:1593–601.

    Article  CAS  Google Scholar 

  6. Pelliccia A, Di Paolo FM, Corrado D, Buccolieri C, Quattrini FM, Pisicchio C, et al. Evidence for efficacy of the Italian national pre-participation screening programme for identification of hypertrophic cardiomyopathy in competitive athletes. Eur Heart J. 2006;27:2196–200.

    Article  Google Scholar 

  7. Vessella T, Zorzi A, Merlo L, Pegoraro C, Giorgiano F, Trevisanato M, et al. The Italian preparticipation evaluation programme: diagnostic yield, rate of disqualification and cost analysis. Br J Sports Med. 2020;54:231–7.

    Article  Google Scholar 

  8. Venerando A, Zeppilli P. Cardiologia dello Sport. Cap. 5. Italy: Masson ed.; 1982.

    Google Scholar 

  9. Corrado D, McKenna WJ. Appropriate interpretation of the athlete’s electrocardiogram saves lives as well as money. Eur Heart J. 2007;28:1920–2.

    Article  Google Scholar 

  10. Zeppilli P, Bianco M. L’elettrocardiogramma dell’atleta. In: Zeppilli P, editor. Cardiologia dello Sport. 5th ed. Rome: CESI; 2014. p. 119–54.

    Google Scholar 

  11. Magalski A, Maron BJ, Main ML, McCoy M, Florez A, Reid KJ, et al. Relation of race to electrocardiographic patterns in elite American football players. J Am Coll Cardiol. 2008;51:2250–5.

    Article  Google Scholar 

  12. Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J. 1949;37:161–86.

    Article  CAS  Google Scholar 

  13. Haydar ZR, Brantley DA, Gittings NS, Wright JG, Fleg JL. Early repolarization: an electrocardiographic predictor of enhanced aerobic fitness. Am J Cardiol. 2000;85:264–6.

    Article  CAS  Google Scholar 

  14. Tikkanen JT, Anttonen O, Junttila MJ, Aro AL, Kerola T, Rissanen HA, et al. Long-term outcome associated with early repolarization on electrocardiography. N Engl J Med. 2009;361:2529–37.

    Article  CAS  Google Scholar 

  15. Haïssaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L, et al. Sudden cardiac arrest associated with early repolarization. N Engl J Med. 2008;358:2016–23.

    Article  Google Scholar 

  16. Macfarlane PW, Antzelevitch C, Haissaguerre M, Huikuri HV, Potse M, Rosso R, et al. The early repolarization pattern: a consensus paper. J Am Coll Cardiol. 2015;66:470–7.

    Article  Google Scholar 

  17. Bianco M, Bria S, Gianfelici A, Sanna N, Palmieri V, Zeppilli P. Does early repolarization in the athlete have analogies with the Brugada syndrome? Eur Heart J. 2001;22:504–10.

    Article  CAS  Google Scholar 

  18. Bianco M, Zeppilli P. Early repolarization in the athlete. J Am Coll Cardiol. 2009;53:2199–200.

    Article  Google Scholar 

  19. Quattrini FM, Pelliccia A, Assorgi R, DiPaolo FM, Squeo MR, Culasso F, et al. Benign clinical significance of J-wave pattern (early repolarization) in highly trained athletes. Heart Rhythm. 2014;11:1974–82.

    Article  Google Scholar 

  20. Papadakis M, Carre F, Kervio G, Rawlins J, Panoulas VF, Chandra N, et al. The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin. Eur Heart J. 2011;32:2304–13.

    Article  Google Scholar 

  21. Rawlins J, Carre F, Kervio G, Papadakis M, Chandra N, Edwards C, et al. Ethnic differences in physiological cardiac adaptation to intense physical exercise in highly trained female athletes. Circulation. 2010;121:1078–85.

    Article  CAS  Google Scholar 

  22. Papadakis M, Basavarajaiah S, Rawlins J, Edwards C, Makan J, Firoozi S, et al. Prevalence and significance of T-wave inversions in predominantly Caucasian adolescent athletes. Eur Heart J. 2009;30:1728–35.

    Article  Google Scholar 

  23. Migliore F, Zorzi A, Michieli P, Perazzolo Marra M, Siciliano M, Rigato I, et al. Prevalence of cardiomyopathy in Italian asymptomatic children with electrocardiographic T-wave inversion at preparticipation screening. Circulation. 2012;125:529–38.

    Article  Google Scholar 

  24. Calò L, Sperandii F, Martino A, Guerra E, Cavarretta E, Quaranta F, et al. Echocardiographic findings in 2261 peripubertal athletes with or without inverted T waves at electrocardiogram. Heart. 2015;101:193–200.

    Article  Google Scholar 

  25. Malhotra A, Dhutia H, Yeo TJ, Finocchiaro G, Gati S, Bulleros P, et al. Accuracy of the 2017 international recommendations for clinicians who interpret adolescent athletes’ ECGs: a cohort study of 11 168 British white and black soccer players. Br J Sports Med. 2020;54:739–45.

    Article  Google Scholar 

  26. Gervasi SF, Bianco M, Palmieri V, Cuccaro F, Zeppilli P. QTc interval in adolescents and young athletes: influence of correction formulas. Int J Sports Med. 2017;38:729–34.

    Article  Google Scholar 

  27. Zeppilli P, Fenici R, Sassara M, Pirrami M, Caselli G. Wenckebach second degree A-V block in top-ranking athletes: an old problem revisited. Am Heart J. 1980;100:281–94.

    Article  CAS  Google Scholar 

  28. Probst V, Kyndt F, Potet F, Trochu JN, Mialet G, Demolombe S, et al. Haploinsufficiency in combination with aging causes SCN5Alinked hereditary Lenègre disease. J Am Coll Cardiol. 2003;41:643–52.

    Article  CAS  Google Scholar 

  29. Pelliccia A, Maron BJ, Culasso F, Di Paolo FM, Spataro A, Biffi A, et al. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation. 2000;18:278–84.

    Article  Google Scholar 

  30. Bianco M, Zeppilli P. Malattie elettriche primitive del cuore. In: Zeppilli P, editor. Cardiologia dello Sport. 5th ed. Rome: CESI; 2014. p. 521–70.

    Google Scholar 

  31. Zeppilli P, Poscolieri B, Pieroni M. Cardiomiopatie, miocarditi e pericarditi in cardiologia dello sport. In: Zeppilli P, editor. Cardiologia dello Sport. 5th ed. Rome: CESI; 2014. p. 749–820.

    Google Scholar 

  32. Sarto P, Merlo L, Noventa D, Basso C, Pelliccia A, Maron BJ. Electrocardiographic changes associated with training and discontinuation of training in an athlete with hypertrophic cardiomyopathy. Am J Cardiol. 2004;93:518–9.

    Article  Google Scholar 

  33. Bianco M, Gervasi SF, Palmieri V, Zeppilli P. Deep and changeable negative T waves in a master athlete. The role of training. Med Sport. 2016;69:447–53.

    Google Scholar 

  34. Smaldone C, Pieroni M, Pelargonio G, Dello Russo A, Palmieri V, Bianco M, et al. Left-dominant arrhythmogenic cardiomyopathy. Circ Arrhythm Electrophysiol. 2011;4:e29–32.

    Article  Google Scholar 

  35. Magalski A, McCoy M, Zabel M, Magee LM, Goeke J, Main ML, et al. Cardiovascular screening with electrocardiography and echocardiography in collegiate athletes. Am J Med. 2011;124:511–8.

    Article  Google Scholar 

  36. Pelliccia A, Culasso F, Di Paolo FM, Accettura D, Cantore R, Castagna W, et al. Prevalence of abnormal electrocardiograms in a large, unselected population undergoing pre-participation cardiovascular screening. Eur Heart J. 2007;28:2006–10.

    Article  Google Scholar 

  37. Kim JH, Noseworthy PA, McCarty D, Yared K, Weiner R, Wang F, et al. Significance of electrocardiographic right bundle branch block in trained athletes. Am J Cardiol. 2011;107:1083–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS—Catholic University of the Sacred Heart, Rome, Italy

    Massimiliano Bianco & Paolo Zeppilli

Authors
  1. Massimiliano Bianco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paolo Zeppilli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paolo Zeppilli .

Editor information

Editors and Affiliations

  1. Ospedale P. Pederzoli, Peschiera del Garda, Italy

    Pietro Delise

  2. Catholic University of the Sacred Heart, Roma, Italy

    Paolo Zeppilli

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bianco, M., Zeppilli, P. (2022). Electrocardiographic Changes in the Athlete’s Heart. In: Delise, P., Zeppilli, P. (eds) Sport-related sudden cardiac death. Springer, Cham. https://doi.org/10.1007/978-3-030-80447-3_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-80447-3_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-80446-6

  • Online ISBN: 978-3-030-80447-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation