Introduction Specific ECG criteria have been proposed to differentiate physiology (athlete¡¯s heart) from pathology that may increase the risk of sudden cardiac death. Although the current European Society of Cardiology (ESC) guidelines have clear criteria for physiological adaptation to intense training, their sensitivity and specificity are sub-optimal and hence the more recent Seattle and Refined criteria have attempted to improve diagnostic accuracy of the athlete¡¯s ECG.
Rugby Football League (RFL) is a moderate dynamic and moderate static sport with recent high profile fatalities linked to inherited cardiomyopathy. This study utilises resting 12-lead ECG, in elite RFL players to compare 3 sets of diagnostic ECG criteria in the athlete and specifically false positive rates.
Methods 103 consecutive, male, elite RFL players (mean age 25¡À4 years) underwent pre-participation cardiac screening. Participants were predominantly white Caucasian (n = 81) with a minority of ethnic backgrounds being represented (Pacific Islander, n = 16; mixed race, n = 5; African-Caribbean, n = 1). All athletes had resting blood pressure assessed and a standard resting 12-lead ECG. In addition all athletes had a standard transthoracic echocardiogram and where indicated further investigations were undertaken. Standard ECG parameters were measured and the ESC recommendations for interpretation of 12-lead ECG in the athlete were used to define normal training (Group 1) and abnormal (Group 2) changes. All ECG¡¯s were also assessed for normality using the Seattle and Refined criteria. False-positive rates were presented for each ECG criteria.
Results Based on ECG, echocardiography and/or follow-up investigation all athletes were considered normal with no evidence of underlying cardiac disease. The continuous ECG measurements are shown in Table 1. According to ESC criteria 95% of athletes had at least one group 1 “normal training-related” ECG change. 58% of athletes had at least one Group 2 ¡®abnormal training-related¡¯ change. This is therefore a false positive rate of 58%. Following application of the revised Seattle and Refined criteria the false-positive rates reduced to 5% and 3% respectively (Table 2).
Conclusion A significant proportion of RFL players present with an abnormal, non-training related, 12-lead ECG according to ESC criteria. In the cardiac screening setting this would result in significant extra cardiac investigation burden. Application of the Seattle and refined criteria decreased the false-positive rate and hence improves ECG specificity in this population.
- Athletes Heart
- Sudden Cardiac Death