CardioSource WorldNews December 2014 - Page 50

INTERVIEW Up For a Challenge? Read the ECGs of Children Athletes at the 3rd acc Sports Cardiology Summit in Indianapolis, CardioSource WorldNews spoke with Sanjay Sharma, MD, a professor of inherited cardiac diseases and sports cardiology at St. George’s University of London. In this interview, Dr. Sharma focuses on the particular challenges of reading the ECGs of athletes and particularly child athletes. CSWN: How do you deal with an athlete’s ECG? Sanjay Sharma, MD: The athlete’s ECG is divided into two main categories: one that reflects increased vagal tone, and the other that reflects increased chamber enlargement. We know that about 80% of athletes would have an ECG that falls into one or both of those categories. These changes include sinus bradycardia, sinus arrhythmia, first-degree AV block, voltage criteria for left ventricular hypertrophy, the lies that we used to consider as abnormal that we would now regard as normal variants. These include the presence of an isolated left axis deviation or right axis deviation, voltage criteria for right or left atrial enlargement, and voltage criteria for right ventricular hypertrophy. If these are found alone or in existence with other so-called “Group 1” exercise stress echocardiography changes, we would consider them as normal if the athlete is asymptomatic, if nothing is found on physical examination, and if there is no family history of a sinister hereditary cardiac condition. We must also take into account ethnicity, because athletes of African-American or Afro-Caribbean origin make up a very large proportion of athletes in the United States and also in many European countries, such as the United Kingdom and France. These individuals do exhibit very profound repolarization changes characterized by convex ST segment elevation and asymmetric deep T-wave inversion in leads V1 to V4. Our studies have shown that these are normal variants and would not require further assessment in most athletes. “The current criteria for ECG interpretation are relatively conservative, and many athletes end up having false-positive tests. That’s the Achilles’ heel of the ECG.” early repolarization pattern, and incomplete right bundle branch block. I should state that these are normal changes. However, many athletes also express very profound repolarization changes that may overlap with disease processes. The current criteria for ECG interpretation are relatively conservative, and many athletes end up having false-positive tests. That’s the Achilles’ heel of the ECG. Now, you are working on some new, updated guidelines in Europe, correct? Yes, we are. We are actually in the process now of revising the 2010 ESE recommendations. It’s been 5 years since we wrote them, and there has been a lot of science since then. There are certain anoma- 48 CardioSource WorldNews What ages are we talking about? With kids getting involved at a younger and younger ages, does that make a difference as to how you’re looking at the ECG? That