Anomalie ECG nell'atleta: Prevalenza e Significato. Dati da un registro "Real Life"

Introduction: The pre-participation screening (PPS) has to be performed on a large scale first with 12-lead electrocardiogram (ECG). The study aims to identify the ECG abnormalities in an unselected athlete’s population of an italian multicenter registry and to correlate them to at risk-heart conditions. Methods: The registry prospectively enrolled 12,758 athletes (7910 males, 62%), aged 14 to 55 years (mean age 20.6±16.3), who underwent the COCIS 2017 protocol. 
All subjects with previously unknown electrocardiographic abnormalities underwent a diagnostic workup with 24-hour ECG Holter, echocardiogram, exercise test and cardiac magnetic resonance (when clinically indicated). Results: 203 abnormal ECGs were found (1.6% of the screened population) with 309 abnormalities detected: 83 T-wave abnormalities, 110 incomplete right bundle branch block (RBBB), 36 complete RBBBs, 19 left anterior fascicular block (LAFB), 14 left posterior fascicular block (LPFB), 8 low voltage, 5 left bundle branch block (LBBB), and finally 10 early repolarizations (ER) with non-benign appearance. Among these 203 subjects, 26 were disqualified from competitive sports. The positive predictive value of having at least one alteration in the baseline ECG was 12.8% compared to detecting a "disqualifying" anomaly. Conclusion: The prevalence of abnormal ECGs in the "real life" registry was lower than in other cohort studies (1.6% vs. 5-7%), but some borderline abnormalities in elite athletes cannot be regarded as physiological in non-elite athletes. These abnormalities have a high predictive value of a condition at risk. These findings highlight the importance of carefully interpreting athletes' ECGs, considering both international criteria and individual and sports-related characteristics.