Early Repolarization in Pediatric Athletes: A Dynamic Electrocardiographic Pattern With Benign Prognosis
Background Early repolarization pattern (ERP) is considered a common training‐related and benign ECG finding in young adult athletes. Few data exist on ERP in the pediatric athletes population. Therefore, we aimed to evaluate the ERP prevalence, characteristics, and prognosis in pediatric athletes a...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.020776 |
| _version_ | 1827932185089277952 |
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| author | Geza Halasz Mattia Cattaneo Massimo Piepoli Andrea Biagi Silvio Romano Vincenzo Biasini Michele Villa Tiziano Cassina Bruno Capelli |
| author_facet | Geza Halasz Mattia Cattaneo Massimo Piepoli Andrea Biagi Silvio Romano Vincenzo Biasini Michele Villa Tiziano Cassina Bruno Capelli |
| author_sort | Geza Halasz |
| collection | DOAJ |
| description | Background Early repolarization pattern (ERP) is considered a common training‐related and benign ECG finding in young adult athletes. Few data exist on ERP in the pediatric athletes population. Therefore, we aimed to evaluate the ERP prevalence, characteristics, and prognosis in pediatric athletes aged ≤16 years. Methods and Results Eight‐hundred eighty‐six consecutive pediatric athletes engaged in 17 different sports (mean age, 11.7±2.5 years; 7–16 years) were enrolled and prospectively evaluated with medical history, physical examination, resting and exercise ECGs, and transthoracic echocardiography during their preparticipation screening. Known cardiovascular diseases associated with sudden cardiac death was considered exclusion criteria. Athletes were followed up yearly for 4 years. The prevalence of ERP was 117 (13.2%), equally distributed in both sexes (P=0.072), irrespectively of body mass index and classification of sports. The most common ERP localizations were inferolateral and inferior leads (53.8% and 27.3%, respectively). Notching J‐point morphology was the most prevalent (70%), and rapidly ascending ST elevation (96%) was the most common ST‐segment morphology. Athletes with ERP were older (P<0.001) had lower rest and recovery heart rates (P<0.001), increased precordial and limb R‐wave voltages (P<0.001), increased R/S Sokolow index (P<0.001), and longer PR interval (P=0.006) in comparison with the athletes without ERP. Neither major cardiovascular nor arrhythmic events, nor sudden cardiac death were recorded over a median follow‐up of 4.2 years. One hundred seventeen (80.3%) athletes with ERP exhibited a persistent ERP. ERP localization and J‐point morphology changed during follow‐up in 11 (11.7%) and 17 (18%) of athletes, respectively. Conclusions ERP is common in pediatric athletes. It was mostly located in the inferolateral leads and associated with concave ascending ST segment with other training‐related ECG changes. The lack of either sudden cardiac death or cardiomyopathies linked to sudden cardiac death over follow‐up suggests that in pediatric athletes, ERP may be considered a benign training‐related ECG phenomenon with a potential dynamic pattern. |
| first_indexed | 2024-03-13T07:06:03Z |
| format | Article |
| id | doaj.art-f3e332a59b0a4430bb9c474391139235 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-13T07:06:03Z |
| publishDate | 2021-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-f3e332a59b0a4430bb9c4743911392352023-06-06T12:10:51ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-08-01101610.1161/JAHA.121.020776Early Repolarization in Pediatric Athletes: A Dynamic Electrocardiographic Pattern With Benign PrognosisGeza Halasz0Mattia Cattaneo1Massimo Piepoli2Andrea Biagi3Silvio Romano4Vincenzo Biasini5Michele Villa6Tiziano Cassina7Bruno Capelli8Cardiology Department Guglielmo Da Saliceto Hospital Piacenza ItalyCardiology Department Cardiocentro Ticino Lugano SwitzerlandCardiology Department Guglielmo Da Saliceto Hospital Piacenza ItalyCardiology Department Guglielmo Da Saliceto Hospital Piacenza ItalyCardiology Department of Life Health & Environmental Sciences University of L'Aquila L'Aquila ItalyItalian Sport Medicine Federation Clinic L'Aquila ItalyCardiovascular Intensive Care Unit Cardiocentro Ticino Lugano SwitzerlandCardiovascular Intensive Care Unit Cardiocentro Ticino Lugano SwitzerlandSport and Exercise Medicine Cardiocentro Ticino Lugano SwitzerlandBackground Early repolarization pattern (ERP) is considered a common training‐related and benign ECG finding in young adult athletes. Few data exist on ERP in the pediatric athletes population. Therefore, we aimed to evaluate the ERP prevalence, characteristics, and prognosis in pediatric athletes aged ≤16 years. Methods and Results Eight‐hundred eighty‐six consecutive pediatric athletes engaged in 17 different sports (mean age, 11.7±2.5 years; 7–16 years) were enrolled and prospectively evaluated with medical history, physical examination, resting and exercise ECGs, and transthoracic echocardiography during their preparticipation screening. Known cardiovascular diseases associated with sudden cardiac death was considered exclusion criteria. Athletes were followed up yearly for 4 years. The prevalence of ERP was 117 (13.2%), equally distributed in both sexes (P=0.072), irrespectively of body mass index and classification of sports. The most common ERP localizations were inferolateral and inferior leads (53.8% and 27.3%, respectively). Notching J‐point morphology was the most prevalent (70%), and rapidly ascending ST elevation (96%) was the most common ST‐segment morphology. Athletes with ERP were older (P<0.001) had lower rest and recovery heart rates (P<0.001), increased precordial and limb R‐wave voltages (P<0.001), increased R/S Sokolow index (P<0.001), and longer PR interval (P=0.006) in comparison with the athletes without ERP. Neither major cardiovascular nor arrhythmic events, nor sudden cardiac death were recorded over a median follow‐up of 4.2 years. One hundred seventeen (80.3%) athletes with ERP exhibited a persistent ERP. ERP localization and J‐point morphology changed during follow‐up in 11 (11.7%) and 17 (18%) of athletes, respectively. Conclusions ERP is common in pediatric athletes. It was mostly located in the inferolateral leads and associated with concave ascending ST segment with other training‐related ECG changes. The lack of either sudden cardiac death or cardiomyopathies linked to sudden cardiac death over follow‐up suggests that in pediatric athletes, ERP may be considered a benign training‐related ECG phenomenon with a potential dynamic pattern.https://www.ahajournals.org/doi/10.1161/JAHA.121.020776early repolarization patternpediatric athletespreparticipation screeningsudden cardiac death |
| spellingShingle | Geza Halasz Mattia Cattaneo Massimo Piepoli Andrea Biagi Silvio Romano Vincenzo Biasini Michele Villa Tiziano Cassina Bruno Capelli Early Repolarization in Pediatric Athletes: A Dynamic Electrocardiographic Pattern With Benign Prognosis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease early repolarization pattern pediatric athletes preparticipation screening sudden cardiac death |
| title | Early Repolarization in Pediatric Athletes: A Dynamic Electrocardiographic Pattern With Benign Prognosis |
| title_full | Early Repolarization in Pediatric Athletes: A Dynamic Electrocardiographic Pattern With Benign Prognosis |
| title_fullStr | Early Repolarization in Pediatric Athletes: A Dynamic Electrocardiographic Pattern With Benign Prognosis |
| title_full_unstemmed | Early Repolarization in Pediatric Athletes: A Dynamic Electrocardiographic Pattern With Benign Prognosis |
| title_short | Early Repolarization in Pediatric Athletes: A Dynamic Electrocardiographic Pattern With Benign Prognosis |
| title_sort | early repolarization in pediatric athletes a dynamic electrocardiographic pattern with benign prognosis |
| topic | early repolarization pattern pediatric athletes preparticipation screening sudden cardiac death |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.020776 |
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