Prevalence and relation to training of electrocardiographic findings in Caucasian children and adolescents 8-18 year-old practicing competitive sport

Background and aims: Training frequently induces electrocardiographic (ECG) changes that mimic heart diseases, requiring specific criteria for interpretation. Pediatric athletes represent a unique population as training-induced changes and those due to sexual maturation interact and specific criteria may be needed. We aimed to assess the prevalence and its relation to training of ECG abnormalities in young athletes aged 8-18 years. Methods: We included 2,458 young apparently healthy Caucasian athletes undergoing preparticipation screening. ECG abnormalities were classified according to the 2017 International criteria (IC) by adding fragmented QRS and low QRS voltages in limb leads. A subgroup analysis was conducted to test the differences according to a 12-year-old age cut-off, the threshold for IC application. Results: Common (>5%) findings included only mild sinus bradycardia (55-60 bpm), early repolarization, incomplete right bundle branch block, voltage criteria for either left or right ventricular hypertrophy and T-wave inversion in V1-V3 before the age of 12. A heart rate of 50-55 bpm, first-degree atrioventricular block, right axis deviation, and T-wave inversion in V1-V3 in athletes 12-16 year-old were uncommon (1-5%) and their prevalence was modulated by age, gender and/or training status. All other ECG findings were rare (<1%). Ten (0.4%) athletes received an at-risk cardiovascular disease diagnosis: six had rare ECG abnormalities, one was uncommon, and three were classified as normal by IC. Conclusions: Pediatric athletes exhibit less prominent ECG changes than their adult counterparts, requiring specific criteria. The significance of certain ECG patterns should be evaluated considering age, sex and training level.