gms | German Medical Science

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Austrian Society of Physical Medicine and Rehabilitation

26.-29.10.2011, Salzburg, Austria

Relation of abnormal ECG patterns with sports classification proposed by Italian Organizing Cardiological Committee on Sports Eligibility (COCIS)

Meeting Abstract

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation. Salzburg, 26.-29.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11esm086

doi: 10.3205/11esm086, urn:nbn:de:0183-11esm0860

Published: October 24, 2011

© 2011 Castagna et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The value of 12-lead ECG in the pre-participation screening of process of athletes is supported by studies showing that ECG is more sensitive than history and physical examination alone in identifying athletes with underlying cardiovascular disease. Cardiovascular remodeling in the athletes is often associated with ECG changes. It is critical to recognize that the prevalence of pathological ECG is immensely affected by criteria chosen to define “abnormal”. The present investigation, therefore, we addressed this problem by assessing the prevalence and the spectrum of ECG abnormalities found in a unselected population of athletes and relation of abnormal ECG patterns with sports classification for COCIS

Material/Methods: We assessed a population of 7353 subjects [5988 (81,43%) males], prospectively examined in Sport Medicine clinics. The ECG patterns were evaluated according to commonly used clinical criteria. Athletes’ ECG abnormalities can be divided into two groups: common and training-related; uncommon and training-unrelated. Sports activities have been formerly classified according to cardiovascular involvement, which took into account the changes in few parameters easy to detect and monitor, such as heart rate and cardiac output, blood pressure, peripheral resistance and degree of sympathetic activation due to emotional involvement. The types of sports can be divided in five groups in according to COCIS 2009. For all the variables, standard statistical indices (mean, median, and standard deviation) were calculated and distribution of frequencies of variables was assessed. The relationship of ECG abnormalities with sports classification was assessed by dividing the overall population in five groups. Comparison of the proportions were assessed by two-sided z test. A P-value of <0.05 was considered statistical significance.

Results: The ECG patterns were considered normal in 6575 of the 7353 athletes (89,42%); abnormal common and training-related (ACTR) in 661 (8,98%) and abnormal uncommon and training-unrelated in 117(1,59%).

The abnormalities common and training-related were: Incomplete RBBB (n=402; 60,81%) Sinus bradycardia (n=157; 23,75%); First degree Av block (n=58;8,77 %), Early repolarisation (n=22; 3,32%) and isolated QRS voltage criteria for LVH (n=21; 3,17%). The most frequent abnormalities uncommon and training-unrelated were T wave inversion (n=41; 35,04%) and Left axis deviation/left anterior hemiblock (n= 35; 29,91%). Finally, with regard to type of sport discipline, from ours analysis, it was evident that prevalence of ECG anomalies are different in accord to COCIS group (Table 1 [Tab. 1]) . The differences of the proportions among types of sport were statistically significant (Figure 1 [Fig. 1]).

Conclusion: Electrocardiogram screening must be conducted using modern criteria to distinguish physiologic cardiac adaptations from underlying pathology and limit unnecessary diagnostic evaluations. Sports classification has only the purpose of providing an indication, and it is dictated by practical need, that are helping sports physicians in evaluating cardiovascular risk reliably. Further studies are needed to test accuracy, utility, and cost-effectiveness of the present ECG criteria in relation to different types of sports.


Corrado D, Basso C, Pavei A, et al. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296:1593-601.
Corrado D, Pelliccia A, Heidbuchel H, et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J. 2010;31:243–59.
Castagna A, Attisani G, et al. Studio di frequenza di anomalie elettrocardiografiche in un gruppo di calciatori [abstract ]. 3° Corso Nazionale Società Italiana di Cardiologia dello Sport Salerno (Italy) marzo 2010
Protocolli cardiologici per il giudizio di idoneità allo sport agonistico 2009 – Edizione del Ventennale – CESI – quarta edizione 2009