ECG in Athletes

Exercise-related sudden death from a previously quiescent cardiac disorder is a highly visible event, particularly when a high-profile athlete is affected. A comprehensive assessment to identify the diverse spectrum of potential causes is cost-prohibitive, given the rarity of such catastrophes. The 12-lead ECG, which is among the simplest of cardiac diagnostic tests, is effective at detecting electrical faults and raise suspicion of structural heart disease; however, participation in regular intensive exercise is associated with physiological, electrical and structural adaptations within the heart that are manifest on the surface ECG and may overlap with disease processes. Such athletes pose a diagnostic dilemma whereby erroneous interpretation of the ECG and subsequent tests has potentially serious consequences. Furthermore, ECG findings in athletes are influenced by age, sex, ethnicity and type of sport. The aim of this chapter is to provide an overview of electrical changes that are considered normal in athletes, after accounting for demographics, and those that should be investigated to exclude serious cardiac disease.