ECG changes in athletes

Last reviewed 03/2022

  • 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

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