The usual changes in the ECG of the athlete - a modern approach

Electrocardiography (ECG) is the most commonly used method of instrumental screening, which can detect phenomena in athletes that are not typical of individuals in the general population. Such electrophysiological phenomena as sinus bradycardia, sinus arrhythmia, functional atrioventricular (AV) block, etc., can lead to errors in the diagnosis and tactics in the athlete. The most well-known algorithm for the interpretation of Domenico Corrado and Antonio Pelliccia (2010) is now extended and supplemented by the criteria of Shrarma S. and Drezner J. A., (2017). Along with the changes previously adopted, arising under the influence of increased vagal and morphological remodeling, paid attention to racial and age influences.

ECG of the athlete, morphological remodeling, electrophysiological remodeling, increased vagal tone, normal ECG findings

1. Corrado D., Pelliccia A., Heidbuchel H. et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. European Heart Journal 2010; 31; 243-259

2. Drezner J. A., Sharma S., Baggish A. et al. International criteria for electrocardiographic interpretation in athletes. Br J Sports Med 2017; 1:1-28

3. Maron B.J., Mitchell J. H. Revised eligibility recommendations for competitive athletes with cardiovascular abnormalities. J. Am. Coll. Cardiol. 1994. V. 24. 848-850; 57-59.

4. Pelliccia A, Maron BJ, Culasso F, et al. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation. 2000;102(3):278-84.

5. Corrado D., Basso C., Schiavon M. et al. Pre-Participation Screening of Young Competitive Athletes for Prevention of Sudden Cardiac Death. Pre-Participation Athletic Screening JACC, 2008; Vol. 52;24; 1981-9

6. Kindermann W. Cardiological screening for the prevention of sudden cardiac death. Medicine matters - UEFA direct. 2004; 10; p.14-17

7. Pigozzi F., Spataro A., Fagnani F. et al. Preparticipation screening for the detection of cardiovascular abnormalities that may cause sudden death in competitive athletes. Br. J. Sports. Med. 2003; 37. p.4-5.

8. Corrado D, Basso C, Schiavon M, et al. Sreening for hypertrophic cardiomyopathy in young athletes. N. Engl. J. Med. 1998. V. 339. p. 364-9.

9. Kurowski K., Chsndran S. The Preparticipation Athletic Evaluation. Am. Fam. Physician. 2000;.61;9; p.2696-8

10. Дегтярёва Е.А., Е. В. Линде, Иде Хасан, ЕА Филатчева, О. А. Муханов, В. С. Сускова Подходы к прогнозированию стрессорной кардиомиопатии у юных спортсменов олимпийского резерва и обоснование методов протекции. Международный медицинский журнал. 2002;6.; С. 521-526

11. Prakash K., Sharma S. Interpretation of the Electrocardiogram in Athletes. Canadian Journal of Cardiology. 2016;32;4; 438-451

12. American College of Sports Medicine Position Stand and American Heart Association. Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Med Sci Sports Exerc 1998; 30:1009-18.

13. Pelliccia A, Maron BJ, Culasso F, et al. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation. 2000. V.102. p. 278-284

14. Crawford M. H. Screening athletes for heart disease. Heart; 2007; 93(7); 875-879

15. Pelliccia A., Di Paolo F.M., M.D., Quattrini F.M. et al. Outcomes in Athletes with Marked ECG Repolarization Abnormalities. N Engl J Med 2008; 358: 152-61.

16. Bille K, Figueras D, Schamasch P, et al. Sudden cardiac death in athletes: the Lausanne recommendations. Eur J Cardiovasc Prev Rehabil 2006; 13: 859-875.

17. Maron B. J., Zipes D. P. et al. 36th Bethesda Conference. Eligibility Recommendations for Competitive Athletes With Cardiovascular Abnormalities. Journal of the American College of Cardiology; 2005; V. 45; № 8.

18. Белоцерковский З. Б. Эргометрические и кардиологические критерии физической работоспособности у спортсменов. М.: Советский спорт, 2005. 318 с.

19. Maron B. J., Zippes D. P. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Preamble, Principles, and General Considerations. JACC2015; V. 66; 21; 2015:2343

20. Дембо А. Г., Земцовский Э. В. Спортивная кардиология: Руководство для врачей. Медицина, 1989. 464 с.

21. Иванов Г. Г., Агеева И. В., Бабаахмади С. и др. Структурное и электрофизиологическое ремоделирование миокарда: определение понятия и применение в клинической практике. Функциональная диагностика. 2003; 1; с. 101-109.

22. Min Xie, Burchfield J. S., Hill J. A. Pathological Ventricular Remodeling: Mechanisms: Part 1 of 2. Circulation. 2013 Jul23; 128(4): 388-400.

23. Bjornstad H. Storstein L., Dyre Meen H. et al. Electrocardiographic and echocardiographic findings in top athletes, athletic students and sedentary controls. Cardiology. 1993. V. 82(1). P. 66-74.

24. Макаров Л.М. ЭКГ в педиатрии. М.: Медпрактика-Х, 2002. 276 с.

25. Карпман В. Л.; Куколевский Г. К. Сердце и спорт: очерки спортивной кардиологии. Под ред. М.: Медицина, 1968. 520 с

26. Бутченко Л. А. Электрокардиография в спортивной медицине. Л., 1963; 208 c

27. Летунов С. П., Мотылянская Р. Е., Граевская Н.Д. Методика врачебно-педагогических наблюдений за спортсменами. М.: Физкультура и спорт; 1962; 400 с.

28. Летунов С. П. Электрокардиография во врачебно-спортивной практике. М.: Физкультура и спорт, 1950; 304 с

29. Лукомский П. Е. Клинические лекции по кардиологии. М. Медицина; 1973; 232 с.

30. Zimmerman F. Clinical Electrocardiography: Review & Study Guide,; McGraw-Hill Professional; 2 edition;2004; 425 p.

31. Kindermann W, Scharhag J: Die physiologische Herzhypertrophie (Sportherz). Dtsch Z Sportmed. 2014; 65: 327-332.

32. Uberoi A., Stein R., Perez M. V. et al. Interpretation of the Electrocardiogram of Young Athletes. Circulation. 2011; 124:746-757

33. Prakash K., Sharma S. Interpretation of the Electrocardiogram in Athletes. Canadian Journal of Cardiology. 2016;32;4; 438-451

34. Huston T., Puffer J., Rodney W. M. The athletic heart syndrome. N. Engl. J. Med. 1985. V. 313(1). p. 24-32.

35. Nakamoto K. Electrocardiograms of 25 marathon runners before and after 100 meter dash. Jpn. Circ. J. 1969. V. 33(3), p.105-128

36. Foote C. B., Michaud G. The athlete's electrocardiogram: distinguishing normal from abnormal. Sudden Cardiac Death in the Athlete; Ed. by Estes NAM III, Salem D., Wang P.J. New York City, Futura. 1998. p. 101-115.

37. Zepilli P. ECG in medicina dello sport - Modificazioni fisiologiche da allenamento e diagnosi differenziale con le principali cardiopatie. Cesi;2009;100 p.

38. Wheeler M. T., Heidenreich P. A., Froelicher V.F. et al. Cost effectiveness of pre-participation screening for prevention of sudden cardiac death in young athletes. Ann Intern Med. 2010 Mar2; 152(5): 276-286.