Abnormal electrocardiographic findings in athletes: Correlation with intensity of sport and level of competition

Helder Dores, Aneil Malhotra, Nabeel Sheikh, Lynne Millar, Harshil Dhutia, Rajay Narain, Ahmed Merghani, Michael Papadakis, Sanjay Sharma

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Introduction: Athletes can exhibit abnormal electrocardiogram (ECG) phenotypes that require further evaluation prior to competition. These are apparently more prevalent in high-intensity endurance sports. The purpose of this study was to assess the association between ECG findings in athletes and intensity of sport and level of competition. Methods: A cohort of 3423 competitive athletes had their ECGs assessed according to the Seattle criteria (SC). The presence of abnormal ECGs was correlated with: (1) intensity of sport (low/moderate vs. at least one high static or dynamic component); (2) competitive level (regional vs. national/international); (3) training volume (textless= 20 vs. textgreater20 hours/week); (4) type of sport (high dynamic vs. high static component). The same endpoints were studied according to the `Refined Criteria' (RC). Results: Abnormal ECGs according to the SC were present in 225 (6.6%) athletes, more frequently in those involved in high-intensity sports (8.0% vs. 5.4%; p=0.002), particularly in dynamic sports, and competing at national/international level (7.1% vs. 4.9%; p=0.028). Training volume was not significantly associated with abnormal ECGs. By multivariate analysis, high intensity sport (OR 1.55, 1.18-2.03; p=0.002) and national/international level (OR 1.50, 95% CI 1.04-2.14; p=0.027) were independent predictors of abnormal ECGs, and these variables, when combined, doubled the prevalence of this finding. According to the RC, abnormal ECGs decreased to 103 (3.0%), but were also more frequent in high-intensity sports (4.2% vs. 2.0%; ptextless0.001). Conclusions: There is a positive correlation between higher intensity of sports and increased prevalence of ECG abnormalities. This relationship persists with the use of more restrictive criteria for ECG interpretation, although the number of abnormal ECGs is lower. (C) 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
Original languageEnglish
Pages (from-to)593-600
Number of pages8
JournalRevista Portuguesa de Cardiologia
Issue number11
Publication statusPublished - Nov 2016


  • Electrocardiogram
  • Athletes
  • Type of sport
  • Competitive level


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