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