The electrocardiogram in the athlete

Interpretation of the athlete’s 12-lead electrocardiogram (ECG) should be based on specific criteria because changes that would be considered abnormal in the untrained population may develop in trained athletes as a physiological and benign consequence of the heart’s adaptation to exercise. ECG abnormalities in athletes are classified into two groups—‘common and training-related’ (Group 1) and ‘uncommon and training-unrelated’ (Group 2)—based on their prevalence, relation to exercise training, association with an increased risk of cardiovascular disease, and need for further investigations. The present chapter reviews the abnormalities that may be found in an athlete ECG and proposes criteria for interpretation of such changes as normal variants or abnormal findings that need further assessment to exclude an underlying cardiac disease.