REF-1071 · Drezner et al., 2017 · British Journal of Sports Medicine, · Paper · PubMed

International criteria for electrocardiographic interpretation in athletes: Consensus statement

Sudden cardiac death is the leading cause of mortality in athletes during sport; most of the disorders behind it in young athletes can be identified or suggested by a resting 12-lead ECG, and an international expert group updated the standards that separate normal training adaptations on an athlete's ECG from abnormal findings needing further evaluation

A-fairly strong evidenceMeasured on a mixed groupWritten before October 2026, being re-checked

An international consensus on how physicians should interpret the resting 12-lead ECG in athletes. An expert group met in Seattle on 26-27 February 2015 to update ECG interpretation standards that had evolved since the original 2010 European Society of Cardiology recommendations, and to produce a clear guide to evaluating ECG abnormalities in athletes. Abstract only was read.

Key Findings

Sudden cardiac death (SCD) is the top cause of death among athletes during sport.
SCD in young athletes is associated with a variety of cardiac disorders, mostly hereditary, structural or electrical; most of them can be picked up or suspected from abnormalities on a resting 12-lead ECG.
Physicians who look after athletes' cardiovascular care need competence in reading athletes' ECGs, yet a shortage of physician expertise in most countries holds back wider use of the ECG; education is critically needed so doctors can tell normal physiological adaptations in athletes apart from clearly abnormal findings that suggest underlying pathology.
Since the original 2010 European Society of Cardiology recommendations, ECG standards have evolved quickly; the group convened on 26-27 February 2015 to define and revise the standards on new and emerging research.
The statement provides expert opinion-based recommendations linking specific ECG abnormalities to the secondary evaluation for conditions associated with SCD. The specific criteria are not in the abstract.

Practical Application

"My son's club wants an ECG before racing — and what if it shows something?" An international consensus (Drezner 2017, A-) says most of the heart conditions behind sudden cardiac death in young athletes can be identified or suggested on a resting 12-lead ECG, and that an athlete's ECG has to be read by a physician against athlete-specific criteria, because training itself changes the ECG in ways that are normal. The assistant does not interpret an ECG or a watch's ECG trace, and does not reassure or alarm on one; that is the physician's job under these criteria.
A "different-looking" ECG in a trained athlete is not by itself a diagnosis: the statement's purpose is to separate normal physiological adaptations from abnormal findings, and the next step for an abnormal one is a physician's secondary evaluation.
Not from this paper; the base's own practice: chest pain, fainting, palpitations or breathlessness out of proportion mean stop and see a doctor before the next ride (SYNTH-81 house rule for teenagers; the same red flags apply to adults); structural "athlete's heart" findings in professional cyclists are REF-198; a wearable signal in known heart disease is REF-1057.

Limitations

The abstract gives no ECG criteria (no lists of normal, borderline or abnormal findings); none are carried here.
By its own description the recommendations are expert opinion-based.
Written for physicians; screening policy (who should be screened, and at what age) is not stated in the abstract.
Abstract only was read; nothing from the full text is used.
How this entry was checked and changed
Why this level

major international consensus statement (rubric A), graded one step down because the statement describes its own recommendations as expert opinion-based (as for the hyponatraemia consensus REF-776)