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The Athlete’s Heart

Article: The Seattle Criteria increase the specificity of pre-participation ECG screening among elite athletes, Brosnan et al., Br J Sports Med 2014 48: 1144-1150

Written by: Jody Murray, Bsc/BPhe, MD, CCFP and current Sport Medicine Fellow

Pre-participation ECG’s have been long debated for athletes.  The European Society of Cardiology (ESC) and other groups such as the International Olympic Committee are now recommending that elite athletes have a pre-participation ECG testing.  This has come as a result of lower sudden cardiac death in Italy’s Veneto region where there has been mandatory ECG screening for the last 30 yrs.

The athletic heart will undergo normal adaptations in response to exercise, which in and of itself, cause electrical changes on ECG.  False positive ECG testing leads to further cardiac investigations for the athlete and unnecessary costs to the health care system which has called into question the significance of ecg testing for athletes.

Recently a set of 3 papers categorizing ECG changes has come out helping to sort out what are normal adaptations versus changes associated with cardiac pathology.  These papers are known as the Seattle Criteria and can be accessed through the British Journal of Sport Medicine.

In 2014, Brosnan et al., decided to look at the Seattle Criteria compared with the ESC criteria in identifying elite Australian athletes with significant cardiac disease which would put them at risk of sudden cardiac death.  As a result of this study they concluded that the use of the Seattle Criteria during ECG interpretation of the elite athlete reduced further screening in individuals from 1 out of 5 athletes to 1 out of 20.  Using the Seattle criteria, they were still able to identify the 3 individuals with significant cardiac abnormalities.  This study suggests that using this new criteria might be as sensitive as using the 2010 ESC guidelines for detection of athletes at risk but with significantly lower the false positive rates and therefore marked cost reduction to our health care system.


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