Purpose T wave inversion (TWI) is the electrical hallmark of cardiac conditions such as hypertrophic cardiomyopathy (HCM) or arrhythmogenic right ventricular cardiomyopathy (ARVC), which may be the substrate for sudden cardiac death in the young athlete. Such repolarization anomalies can feature on the ECG of an apparently healthy athlete and pose major diagnostic dilemmas in sports cardiology, as regular, prolonged high intensity, physical activity is associated with such repolarization changes. Athletes themselves are reluctant to detrain during the season, which makes interpreting any reversible effects of exercise on the ECG more difficult. This study aimed to investigate the effect of detraining on TWI in athletes.
Methods Between 2013–2014, 36 professional footballers demonstrated TWI at mid-season ECG screenings (trained period). They were followed up during the “off-season” after a period of detraining (6–8 weeks). TWI was defined as −0.1 mV or greater 2 or more contiguous leads, in the anterior leads-V2-V3/4; inferior-II, III, aVF; or lateral-beyond V4 +/- aVL. Comparisons were drawn by 2 independent cardiologists, between trained and detrained ECG repolarization patterns. Every individual was subsequently investigated for an underlying cardiomyopathy.
Results Athletes were male and aged 24.5+/-2.7 years. 27 (75%) were Afro-Caribbean and 25% Caucasian (p = 0.0141). TWI was most commonly observed in the anterior leads (n = 20, 55%), followed by inferior (n = 10, 28%) and lateral (n = 6, 17%). No Caucasian player had TWI in the lateral leads. After detraining, 16 players demonstrated resolution of anterior TWI (80%, p = 0.0293), 8 in inferior leads (80%, p = 0.2353) and 4 in the lateral leads (67%, p = 0.638) (Figure 1). All players with abnormal TWI according to consensus guidelines were comprehensively evaluated with no cardiomyopathy identified.
Conclusion/implications Convincing athletes to detrain in order to interpret repolarisation anomalies is particularly difficult, due to enthusiasm for continued participation and reluctance to stop exercising. In our cohort of athletes who did detrain during the ‘off-season’, we observed resolution of TWI in the majority of athletes (both Afro-Caribbean and Caucasian) after a relatively brief period of detraining which may be deemed a physiological phenomenon. This was statistically significant in the anterior leads. However, TWI in the inferior and/or lateral leads should always raise the suspicion of an underlying cardiomyopathy, especially if persistent after detraining.
- T wave inversion
- training/detraining effects
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