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ECG in athletes

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • there is a wider range of normality in ECGs of athletes than the 'normal population'
  • some possible ECG features seen in an athlete have been described by Hampton and include (1)
    • there is often a sinus bradycardia due to increased levels of physical fitness
    • there may be first degree heart block or second degree heart block of the Wenkebach type
    • width of QRS is normal
    • it is relatively common to find tall complexes in V5 and deep S waves in V1 and V2 - this may show the so-called 'voltage criteria' for left ventricular hypertrophy (R plus S greater than 35 mm)

  • a more detailed review of ECG abnormalities in the athlete population has been undertaken (2,3)
    • 7% of young athletes have an abnormal ECG compared with 40% of adult elite athletes
      • the difficulty lies in differentiating between what is normal for an athlete and what requires further investigation
        • A table looking to differentiate between Athlete's Heart, and ECGs requiring further investigation has been produced by Corrado et al (2)

Group 1: common and training-related ECG changes

Group 2: uncommon and training-unrelated ECG changes

Sinus bradycardia

First-degree AV block

Incomplete RBBB

Early repolarization

Isolated QRS voltage criteria for left ventricular hypertrophy

T-wave inversion

ST-segment depression

Pathological Q-waves

Left atrial enlargement

Left-axis deviation/left anterior hemiblock

Right-axis deviation/left posterior hemiblock

Right ventricular hypertrophy

Ventricular pre-excitation

Complete LBBB or RBBB

Long- or short-QT interval

Brugada-like early repolarization

  • RBBB, right bundle branch block; LBBB, left bundle branch block.
  • a patient with ECG abnormalities in group 2 requires further investigation
  • a patient with no other worrying features on clinical evaluation with group 1 changes only will likely be fit to participate

Click here for further information


  • Dr Andrew Murray, Dr Duncan Goodall
    • Marathon Medical Services
  • Prof Hillis
    • Professor of Cardiology and Exercise Medicine, University of Glasgow



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