PhD Scientific Days 2024

Budapest, 9-10 July 2024

Poster Session N - Cardiovascular Medicine and Research 2.

Interpretation of athlete's ECG in a pediatric population using the International Criteria


Francesca Graziano1, Dorottya Balla2, Laura Manfrin1, Laura Brusamolin3, Franco Giada4, Domenico Corrado1, Alessandro Zorzi1, Hajnalka Vago2
1: University of Padova, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, Padova, Italy
2: Heart and Vascular Centre, Semmelweis University, Budapest, Hungary.
3: AULSS6 Euganea, Sports Medicine Unit, Padua, Italy
4: Noale Hospital, Sports Medicine and Cardiovascular Rehabilitation Unit, Cardiovascular Department, AULSS3, Noale, Italy

Text of the abstract

Introduction: Current International Criteria for ECG interpretation in athletes are recommended for subjects between 12 and 35 years of age, but sometimes pre-participation screening (PPS) includes individuals younger than 12 years.
Aims: To define the prevalence of ECG alterations (normal, borderline, abnormal) in the ≤12 years population compared to older athletes, and to define which of these are training-related. To assess the applicability of the 2017 International Criteria to a population ≤12 year-old.
Methods: Athletes of both sexes, aged 7-18 years, undergoing PPS in the period 2019-2022, regardless of the sport discipline, were retrospectively enrolled. The ECG was interpreted according to the recommendations of the 2017 International Criteria.
Results: The final population was composed by 2140 athletes (mean age 12.5 ±2.61 years, 60% ≤12 years). No statistically significant differences were found in the percentage of normal (98% vs 97%, p=0.4), borderline (1.8% vs 1.5%, p=0.5) and abnormal (0.5% vs 1.2%, p=0.06) alterations in the group ≤12 years compared to >12 years. The most frequently observed ECG abnormalities were incomplete right bundle branch block (iRBBB, 22.8%), early repolarisation (14.8%) and left ventricular hypertrophy (13.8%). When comparing the two age groups, a statistically significant difference was found in the prevalence of sinus bradycardia (SB, 0.6% vs 8.2%, p<0.001), 1st degree atrio-ventricular block (AVB, 0.2% vs 1.6% p<0.001) and T-wave inversion in V1-V3 (7.3% vs 2.3%, p<0.001). Furthermore, in the younger age group, there was no correlation between the prevalence of these ECG changes and the level of training.
Conclusions: SB and 1st degree AVB are extremely rare in athletes ≤12 year-old and do not appear to be training-related, and therefore should be considered as abnormal findings in this population. Furthermore, in both groups, complete RBBB, 2nd degree Mobitz 1 AVB and the presence of one premature ventricular beat on ECG should also be classified as abnormal. The results highlight the limitations of using International Criteria for the interpretation of the athlete's ECG in young people under 18 years, and particularly under 12.
Funding: TKP2021-NKTA-46; K135076.