Table 1

ECG features of cardiac diseases detectable at preparticipation screening in young competitive athletes

DiseaseQTc intervalP wavePR intervalQRS complexST intervalT waveArrhythmias
Hypertrophic cardiomyopathyNormal(Left atrial enlargement)NormalIncreased voltages in mid and left precordial leads; abnormal Q waves† in inferior and/or lateral leads; (LAD, LBBB); (delta wave)Down-sloping (up-sloping)Inverted in mid and left precordial leads; (giant and negative in the ‘apical’ variant)(Atrial fibrillation); (PVB); (VT)
ARVC/dysplasiaNormalNormalNormalProlonged >110 ms in right precordial leads; epsilon wave in right precordial leads; reduced voltages ≤0.5 mV in frontal leads; (RBBB)(Up-sloping in right precordial leads)Inverted in right precordial leadsPVB with an LBBB pattern; (VT with an LBBB pattern)
Dilated cardiomyopathyNormal(Left atrial enlargement)(Prolonged ≥0.21 s)LBBBDown-sloping (up-sloping)Inverted in inferior and/or lateral leadsPVB; (VT)
Myocarditis(prolonged)NormalProlonged ≥0.21 s(Abnormal Q waves)Down- or up-slopingInverted in ≥2 leads(Atrial arrhythmias); (PVB); (2nd or 3rd degree AV block); (VT)
Long QT syndromeProlonged >440 ms in males, >460 ms in femalesNormalNormalNormalNormalBifid or biphasic in all leads(PVB); (torsade de pointes)
Brugada syndromeNormalProlonged ≥0.21 sS1S2S3 pattern; (RBBB/LAD)Up-sloping ‘coved-type’ in right precordial leadsInverted in right precordial leads(Polymorphic VT); (atrial fibrillation) (sinus bradycardia)
Lenègre diseaseNormalNormalProlonged ≥0.21 sRBBB; RBBB/LAD; LBBBNormalSecondary changes(2nd or 3rd degree AV block)
Short QT syndromeShortened <300 mNormalNormalNormalNormalNormalAtrial fibrillation (polymorphic VT)
Pre-excitation syndrome (WPW)NormalNormalShortened <0.12 sDelta waveSecondary changesSecondary changesSupraventricular tachycardia; (atrial fibrillation)
Coronary artery diseases*(Prolonged)NormalNormal(Abnormal Q waves)(Down- or up-sloping)Inverted in≥2 leadsPVB; (VT)
  • Modified from Corrado et al.9

  • Less common or uncommon ECG findings are reported in parentheses.

  • *Coronary artery diseases =either premature coronary atherosclerosis or congenital coronary anomalies.

  • ARVC, arrhythmogenic right ventricular cardiomyopathy; LAD, left axis deviation of −30° or more; LBBB, left bundle branch block; PVB, either single or coupled premature ventricular beats; RBBB, right bundle branch block; QTc, QT interval corrected for heart rate by Bazett's formula; VT, either non-sustained or sustained ventricular tachycardia; WPW, Wolff-Parkinson-White.