Frequency of Electrocardiographic Changes in Trained Athletes in the Republic of Macedonia

Ivanka Karagjozova; Suncica Petrovska; Slobodan Nikolic; Vesela Maleska-Ivanovska; Ljubica Georgievska-Ismail

doi:10.3889/oamjms.2017.174

Authors

Ivanka Karagjozova Institute of Physiology and Anthropology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
Suncica Petrovska Institute of Physiology and Anthropology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
Slobodan Nikolic Institute of Physiology and Anthropology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
Vesela Maleska-Ivanovska Institute of Physiology and Anthropology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje
Ljubica Georgievska-Ismail University Clinic of Cardiology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje

DOI:

https://doi.org/10.3889/oamjms.2017.174

Keywords:

trained athletes, 12-lead electrocardiography, screening for cardiovascular diseases

Abstract

BACKGROUND: The use of a 12-lead electrocardiogram (ECG) in the screening of young athletes still has some controversies regarding the cost-benefit of the procedure.

AIM: We wanted to identify types and frequency of ECG changes in athletes in the Republic of Macedonia as well as its relation to age, gender, duration, frequency and type of sports.

METHODS: The study population included 256 trained amateur athletes who were prospectively examined.

RESULTS: The 12-lead ECG patterns were considered normal in 19.9% of athletes, with common training-related changes found in 48.8%, while abnormal and borderline ECG changes were present in 6.6% and 24.6% of athletes respectively. ECG changes were more frequent in males than in females without significant difference regarding the age of athletes. There was a significant correlation between more pronounced ECG changes and longer duration of sports engagement, higher duration of sports activity and type of sport practised.

CONCLUSION: The prevalence of abnormal ECG patterns in athletes in RM which could indicate structural cardiac disease and greater risk of sudden cardiac death exist in a proportion that should implicate mandatory 12-lead ECG in the pre-participation screening program and further on the regular annual basis.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Maron BJ. Sudden death in young athletes. N Eng J Med. 2003;349:1064-75. https://doi.org/10.1056/NEJMra022783 PMid:12968091 DOI: https://doi.org/10.1056/NEJMra022783

Chandra N, Bastiaenen R, Papadakis M, Sharma S. Sudden cardiac death in young athletes. Practical challenges and diagnostic dilemmas. J Am Coll Cardiol. 2013;61:1027-40. https://doi.org/10.1016/j.jacc.2012.08.1032 PMid:23473408 DOI: https://doi.org/10.1016/j.jacc.2012.08.1032

Ackerman M, Atkins DL, Triedman JK. Sudden cardiac death in the young. Circulation. 2016;133:1006-26. https://doi.org/10.1161/CIRCULATIONAHA.115.020254 PMid:26951821 PMCid:PMC5033115 DOI: https://doi.org/10.1161/CIRCULATIONAHA.115.020254

Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a pre-participation screening program. JAMA. 2006;296:1593-1601. https://doi.org/10.1001/jama.296.13.1593 PMid:17018804 DOI: https://doi.org/10.1001/jama.296.13.1593

Pelliccia A, Culasso F, Di Paolo FM, Accettura D, Cantore R, Castagna W, et al. Prevalence of abnormal electrocardiograms in a large, unselected population undergoing pre-participation cardiovascular screening. Eur Heart J. 2007;28:2006-10. https://doi.org/10.1093/eurheartj/ehm219 PMid:17623682 DOI: https://doi.org/10.1093/eurheartj/ehm219

Corrado D, Basso C, Schiavon M, Pelliccia A, Thiene G. Pre- participation screening of young competitive athletes for prevention of sudden cardiac death. J Am Coll Cardiol. 2008;52:1981-9. https://doi.org/10.1016/j.jacc.2008.06.053 PMid:19055989 DOI: https://doi.org/10.1016/j.jacc.2008.06.053

Papadakis M, Sharma S. Electrocardiographic screening in athletes: the time is now for universal screening. Br J Sports Med. 2009;43:663-8. https://doi.org/10.1136/bjsm.2008.054874 PMid:19734500 DOI: https://doi.org/10.1136/bjsm.2008.054874

Steinvil A, Chundadze T, Zeltser D, Rogowski O, Halkin A, Galily D, et al. Mandatory electrocardiographic screening of athletes to reduce their risk for sudden death. J Am Coll Cardiol. 2011;57:1291-6. https://doi.org/10.1016/j.jacc.2010.10.037 PMid:21392644 DOI: https://doi.org/10.1016/j.jacc.2010.10.037

Harmon KG, Zigman M, Drezner JA. The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: A systematic review/meta-analysis. J Electrocardiol. 2015;48:329-38. https://doi.org/10.1016/j.jelectrocard.2015.02.001 PMid:25701104 DOI: https://doi.org/10.1016/j.jelectrocard.2015.02.001

Corrado D, Pelliccia A, Heidbuchel H, Sharma S, Link M, Basso C, et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J. 2010;31:243-59. https://doi.org/10.1093/eurheartj/ehp473 PMid:19933514 DOI: https://doi.org/10.1093/eurheartj/ehp473

Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, et al. International Recommendations for Electrocardiographic Interpretation in Athletes. J Am Coll Cardiol. 2017; 69:1057-75. https://doi.org/10.1016/j.jacc.2017.01.015 PMid:28231933 DOI: https://doi.org/10.1016/j.jacc.2017.01.015

Uberoi A, Stein R, Perez MV, Freeman J, Wheeler M, Dewey F, et al. Interpretation of the electrocardiogram of young athletes. Circulation. 2011;124:746-57. https://doi.org/10.1161/CIRCULATIONAHA.110.013078 PMid:21824936 DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.013078

Mitchell JH, Haskell W, Snell P, Van Camp SP. Task force 8: classification of sports. J Am Coll Cardiol. 2005;45:1364-7. https://doi.org/10.1016/j.jacc.2005.02.015 PMid:15837288 DOI: https://doi.org/10.1016/j.jacc.2005.02.015

Corrado D, Biffi A, Basso C, Pelliccia A, Thiene G. 12-lead ECG in the athlete: physiological versus pathological abnormalities. Br J Sports Med. 2009;43:669-76. https://doi.org/10.1136/bjsm.2008.054759 PMid:19734501 DOI: https://doi.org/10.1136/bjsm.2008.054759

Drezner JA, Fischbach P, Froelicker V, Marek J, Pelliccia A, Prutkin JM, et al. Normal electrocardiographic findings: recognizing physiological adaptations in athletes. Br J Sports Med. 2013;47:125-36. https://doi.org/10.1136/bjsports-2012-092068 PMid:23303759 DOI: https://doi.org/10.1136/bjsports-2012-092068

Drezner JA, Ashley E, Baggish AL, Borjesson M, Corrado D, Owens DS, et al. Abnormal electrocardiographic findings in athletes: recognizing changes suggestive of cardiomyopathy. Br J Sports Med. 2013;47:137-52. https://doi.org/10.1136/bjsports-2012-092069 PMid:23303760 DOI: https://doi.org/10.1136/bjsports-2012-092069

Thompson AJ, Cannon BC, Wackel PL, Horner JM, Ackerman MJ, O'Leary PW, et al. Electrocardiographic abnormalities in elite high school athletes: comparison to adolescent hypertrophic cardiomyopathy. Br J Sports Med. 2016;50:105-10. https://doi.org/10.1136/bjsports-2015-094880 PMid:26729893 DOI: https://doi.org/10.1136/bjsports-2015-094880

Pelliccia A, Maron BJ, Culasso F, Di Paolo FM, Spataro A, Biffi A, et al. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation. 2000;102:278-84. https://doi.org/10.1161/01.CIR.102.3.278 PMid:10899089 DOI: https://doi.org/10.1161/01.CIR.102.3.278

Sohaib SM, Payne JR, Shukla R, World M, Pennell DJ, Montgomery HE. Electrocardiographic (ECG) criteria for determining left ventricular mass in young healthy men; data from the LARGE Heart study. J Cardiovasc Magn Reson. 2009; 11:2. https://doi.org/10.1186/1532-429X-11-2 PMid:19149884 PMCid:PMC2647921 DOI: https://doi.org/10.1186/1532-429X-11-2

Kim JH, Noseworthy PA, McCarty D, Yared K, Weiner K, Wang F, et al. Significance of electrocardiographic right bundle branch block in trained athletes. Am J Cardiol. 2011;107:1083-9. https://doi.org/10.1016/j.amjcard.2010.11.037 PMid:21296331 DOI: https://doi.org/10.1016/j.amjcard.2010.11.037

Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation. 2010;121:1533-41. https://doi.org/10.1161/CIRCULATIONAHA.108.840827 PMid:20172911 PMCid:PMC2860804 DOI: https://doi.org/10.1161/CIRCULATIONAHA.108.840827

Zhang L, Liu L, Kowey PR and Fontaine GH. The electrocardiographic manifestation of arrhythmogenic right ventricular dysplasia. Curr Cardiol Rev. 2014; 10:237-45. https://doi.org/10.2174/1573403X10666140514102928 PMid:24827798 PMCid:PMC4040875 DOI: https://doi.org/10.2174/1573403X10666140514102928

Papadakis M, Basavarajaiah S, Rawlins J, Edwards C, Makan J, Firoozi S, et al. Prevalence and significance of T-wave inversions in predominantly Caucasian adolescent athletes. Eur Heart J. 2009;30:1728-35. https://doi.org/10.1093/eurheartj/ehp164 PMid:19429915 DOI: https://doi.org/10.1093/eurheartj/ehp164

Schnell F, Riding N, O'hanlon R, Lentz PA, Donal E, Kervio G, et al. Recognition and significance of pathological T-wave inversions in athletes. Circulation. 2015; 131:165-73. https://doi.org/10.1161/CIRCULATIONAHA.114.011038 PMid:25583053 DOI: https://doi.org/10.1161/CIRCULATIONAHA.114.011038

Rowin EJ, Maron BJ, Appelbaum E, Link MS, Gibson CM, Lesser JR, et al. Significance of false negative electrocardiogram in preparticipation screening of athletes for hypertrophic cardiomyopathy. Am J Cardiol. 2012; 110:1027-32. https://doi.org/10.1016/j.amjcard.2012.05.035 PMid:22809754 DOI: https://doi.org/10.1016/j.amjcard.2012.05.035

Pelliccia A, Di Paolo FM, Quattrini FM, Basso C, Culasso F, Popoli G, et al. Outcomes in athlees with marked ECG repolarizatioan abnormalities. N Engl J Med. 2008; 358:152-61. https://doi.org/10.1056/NEJMoa060781 PMid:18184960 DOI: https://doi.org/10.1056/NEJMoa060781

BjÃ¸rnstad H, Storstein L, Meen HD and Hals O. Electrocardiographic findings according to level of fitness and sport activity. Cardiology. 1993; 83: 268-79. https://doi.org/10.1159/000175980 PMid:8281544 DOI: https://doi.org/10.1159/000175980

Gademan MGJ, Uberoi A, Le VV, Mandic S, van Oort ER, Myers J and Froelicher VF. The effect of sport on computerized electrocardiogram measurements in college athletes. Eur J Prev Cardiol. 2012;19:126-38. https://doi.org/10.1177/1741826710392669 PMid:21450619 DOI: https://doi.org/10.1177/1741826710392669