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Supranormal ECG: Athlete’s Heart

Author : Aprihati, E.D. Hargiyanto, D. Wijayanti, M.Y. Alsagaff
Upload Date : 19-04-2018

Background: Interpretating electrocardiogram (ECG) in athletes are quite challenging because some ECG pattern which is abnormal in general population can be normal variant in athletes. Regular intensive participation in sport results in electrical and structural alterations within the heart that can manifest on the surface ECG. The prevalence, pattern and degree of  ECG changes are not uniform among athletes and are dependent on various factors including age, gender, and ethnicity. The association between the type of sport and ECG findings in athletes is not well established.

Objective: To determine the pattern of athlete’s ECG in East Java Regional Sport Training Center and to assess the association between the type of sports and ECG findings in athletes.

Methods: We cross-sectionally collected data from the health screening of athletes in East Java Regional Sport Training Center in September - October 2017. Athletes from all types of sport were included. The association between variables were analysed using chi-square test.

Result: This study included 260 athletes. Based on International Recommendations for Electrocardiographic Interpretation in Athletes, 236 athletes had normal ECG (90.8%), 16 athletes had borderline ECG (6,2%), and 8 athletes had abnormal ECG (3.1%).  Bradycardia was the most frequent ECG findings in normal ECG (38.6%). Sinus arrhythmia were found in 17.18%  athletes with normal ECG. The abnormal ECG  findings were T wave inversion (TWI) in anterolateral, TWI in inferior , TWI in anterior , complete LBBB, first-degree AV block in which PR interval > 400ms, and sinus pause > 3 second with  junctional escape rhythm. TWI inferior were the most frequent abnormal ECG findings. We found significant association between type of sports with ECG pattern in athletes. The dynamic sports was significantly associated with bradycardia and TWI in inferior  lead in athletes (respectively p=0.031, p=0.004 ). While the  static sports were significantly associated with sinus arrhythmia (p=0.046).

Discussion : ECG findings in athletes influenced by age, gender, ethnicity, and type of sport. This study showed that dynamic sports was associated with bradycardia and TWI in inferior lead. The static sport was associated with sinus arrhythmias. Previous studies reported that the dynamic sports reveal the highest prevalence of of bradycardiarrythmia pattern. No study reported about the association between TWI in inferior lead with type of sports.

Conclusion: The ECG of an athlete frequently demonstrates many variants that are benign and represent the normal physiological adaptation to exercise. This study showed that the dynamic sports were associated with bradycardia and TWI in inferior lead in ECG, while the static sports  were associated with sinus arrhythmia.

KEYWORDS : Electrocardiogram, ECG, Athletes, type of sports

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