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Das EKG beim Sportler

The ECG of athletes

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Einleitung

Über längere Zeit war die Rolle des Ruhe-EKGs bei Sportlern umstritten. Die Validität war unzureichend, und es kam recht häufig zu falsch-positiven und falsch-negativen Befunden. In den letzten Jahren wurden durch verschiedene Untersuchergruppen Kriterien erarbeitet, die eine Abgrenzung eines normalen von einem pathologischen EKG-Befund beim Sportler erheblich verbessert haben.

Methoden

Heute lassen sich normale Befunde beim Sportler von abnormen EKG-Bildern zuverlässiger abgrenzen. Die Unterstützung durch eine entsprechende Software in den EKG-Geräten erleichtert dies erheblich. Im Vordergrund stehen typische sportbedingte Befunde mit Sinusbradykardie, AV-Blockierungen und Zeichen der Linkshypertrophie als typisch für den Ausdauersportler.

Ergebnisse

Abnorme Veränderungen werden bei strukturellen Herzkrankheiten mit Kardiomyopathien beobachtet sowie bei elektrischen Veränderungen, insbesondere bei Ionenkanalerkrankungen und dem Präexzitationssyndrom. Vorhofflimmern ist eine weitere, neue Variante von EKG-Veränderungen bei älteren Ausdauersportlern.

Schlussfolgerung

Die Beurteilung des EKGs eines Sportlers setzt eingehende, aktuelle sportkardiologische Kenntnisse und umfangreiche Erfahrungen voraus. Die Bewertung kann nur im Zusammenhang mit Anamnese, klinischen Daten und ethnischer Herkunft erfolgen. Eine sportkardiologische Fortbildung ist heute dringend zu empfehlen, um Sportler jeden Alters, auch im Kindes-und Jugendalter, vor möglichen kardialen Zwischenfällen zu schützen.

Abstract

Introduction

There has been a long standing controversy on the role of a resting electrocardiogram (ECG) in the preparticipation examination of athletes, as well as in children and adolescents, in leisure time and competitive athletes. Besides other arguments, this was due to the limited validity, which led to false positive and false negative findings.

Methods

Recent studies from different research groups yielded a significant improvement in establishing ECG criteria in athletes to discriminate normal from abnormal or pathological findings in athletes. This is additionally supported and improved by a software-based ECG device considering the new Seattle criteria. These new criteria from the Seattle conference reliably discriminate normal from abnormal findings. Frequent ECG findings in athletes, especially in those engaged in endurance sports are sinus bradycardia, atrioventricular (AV) block and signs of left ventricular hypertrophy.

Results

Abnormal findings are related to structural left ventricular alterations due to cardiomyopathy, mainly hypertrophic with or without outflow tract obstruction, arrhythmogenic right ventricular cardiomyopathy (ARVC) and dilated cardiomyopathy. The ECG findings suggestive of electrical conductance disorders are observed in channelopathies, Wolff-Parkinson-White (WPW) syndrome supraventricular arrhythmias or disturbances of cardiac conduction. The main diseases are long or short QT syndrome, Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia. Atrial fibrillation, mostly paroxysmal, is also now more frequently observed especially in middle aged endurance athletes.

Conclusion

Interpretation of ECG in young and older athletes requires in-depth knowledge in cardiology and sports medicine. The interpretation can only be carried out by considering medical history, clinical examination and ethnicity. Profound and long-term experience of athlete’s ECG interpretation is required to protect athletes and to prevent cardiac emergencies.

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Authors and Affiliations

  1. Innere Medizin, Kardiologie, Sportkardiologie, Praxis für Kardiologie, Daniel-Schürmann-Str. 14, 42853, Remscheid, Deutschland

    Herbert Löllgen FACC, FAHA, FFIMS

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  1. Herbert Löllgen FACC, FAHA, FFIMS
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Correspondence to Herbert Löllgen FACC, FAHA, FFIMS.

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H. Löllgen gibt an, dass kein Interessenkonflikt besteht.

Diese Arbeit enthält keine Studien an Menschen oder Tieren.

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Löllgen, H. Das EKG beim Sportler. Herzschr Elektrophys 26, 274–290 (2015). https://doi.org/10.1007/s00399-015-0388-0

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