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Athletes' ECG - the Seattle Criteria

Comment by Erik Ekker Solberg, EACPR Sports Cardiology Section

Regular physical exercise may lead to a number of cardiovascular adaptations which constitute what is known as the athlete’s heart.

The athlete’s heart is reflected on the 12-lead electrocardiogram (ECG) with common, training-related changes. Athletes may, however, exhibit ECG phenotypes that are commonly present in cardiac disease and the differentiation between physiology and pathology can be challenging even for the most experienced of physicians.

Sports Cardiology

The EACPR Sports Cardiology Section produced  recommendations relating to the interpretation of the athlete’s ECG, which were updated in 2010. Although these recommendations have assisted physicians worldwide with the evaluation of athletic individuals, they are associated with a fairly high false positive rate, raising concern of unnecessary investigations and false disqualification from sport.

In an attempt to refine the ECG evaluation and create a practical tool for physicians, a worldwide team of experts, including five nucleus members of the Sports Cardiology Section, revised the criteria that should prompt further investigations for quiescent heart disease. The group led by Jonathan Drezner, Seattle, presented their views in four educational articles on:

1) Abnormal electrocardiographic findings in athletes: recognising changes suggestive of primary electrical disease
J A Drezner et al.
Br J Sports Med 2013;47:153-167 doi:10.1136/bjsports-2012-092070
2) Abnormal electrocardiographic findings in athletes: recognising changes suggestive of cardiomyopathy
J A Drezner et al.
Br J Sports Med 2013;47:137-152 doi:10.1136/bjsports-2012-092069
3) Electrocardiographic interpretation in athletes: the ‘Seattle Criteria’
J A Drezner et al.
British Journal of Sports Medicine 2013;47:122-124 doi:10.1136/bjsports-2012-092067
4) Normal electrocardiographic findings: recognising physiological adaptations in athletes
J A Drezner et al.
British Journal of Sports Medicine 2013;47:125-136 doi:10.1136/bjsports-2012-092068

The main goal of these articles was to provide a simple and clinically useful tool for the practitioner to distinguish whether or not their athlete's ECG is pathological.

The second goal was to provide easy accessible recommendations worldwide also from a mobile app (AMSSM*, F-MARC** and BJSM***) for optimal educational importance.

These papers represent an important step forward in the care of athletes.

*American Medical Society for Sports Medicine (AMSSM)
**FIFA Medical Assessment and Research Center (F-MARC)
***British Journal of Sports Medicine (BJSM)