The following ECG abnormalities may be observed in well-trained athletes and are not generally regarded as abnormal

  Sinus bradycardia.

                - Normally the heart rate should increase during exercise in athletes (as in the normal healthy population).

                - In athletes, sinus bradycardia generally does not result in syncope or dizziness.

                - In athletes, no further investigation is needed unless heart rate decreases below 30/minute at rest.

                - The sinus bradycardia at rest
may diasappear after cessation of professional athletic training .

  Sinus arrhythmia. No need for further investigation unless there is a pause > 3 seconds

      while the patient is awake (during daytime).

  Early repolarization (in 50% of the athletes)

  Left ventricular hypertrophy (increased QRS voltage)

  First-degree atrioventricular (AV) block (35%).
Generally disappears during exercise .

  2nd degree, type 1 (Wenkebach) atrioventricular (AV) block (10%).
Generally disappears during exercise .

  Right bundle branch block pattern (35%) (
may disappear after the cessation of professional athletic training ).

  Persistent juvenile T pattern (negative T waves in leads V1 to V3)





The following ECG abnormalities are not related to sports.

When observed in an athlete's ECG, they call for further investigation:


  T wave negativity other than juvenile T wave pattern:

                - Negative T waves in lateral or inferior leads is usually abnormal.

                - Deep T wave negativity in any lead.

  ST segment depression

  Left atrial abnormality

  Pathological Q waves

  Left axis deviation / left anterior hemiblock

  Right axis deviation / left posterior hemiblock

  Left or right bundle branch block

  Right ventricular hypertrophy pattern

  Preexcitation pattern

  Long QT interval

  Short QT interval

  Brugada pattern




References

  Eur Heart J 2009;30:1728-1735.

  Eur Heart J 2010;31,243-259.