Prevalence and clinical significance of isolated low QRS voltages in young athletes . Issue 9 (4th March 2022)

• Record Type: Journal Article
• Authors: Zorzi, Alessandro; Bettella, Natascia; Tatangelo, Mario; Del Monte, Alvise; Vessella, Teresina; Poscolieri, Barbara; Crescenzi, Cinzia; Pegorin, Davide; D'Ascenzi, Flavio; Pescatore, Valentina; Giada, Franco; Sarto, Patrizio; Calò, Leonardo; Schiavon, Maurizio; Gregori, Dario; Hadley, David M; Drezner, Jonathan A; Pelliccia, Antonio; Corrado, Domenico
• Is Part Of: Europace. Volume 24:Issue 9(2022)
• Page Start: 1484
• Page End: 1495
• Publication Date: 2022-03-04
• Subjects: Athlete's heart -- Electrocardiogram -- Cardiomyopathy -- Screening -- Sports cardiology; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euab330
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Low QRS voltages (peak to peak <0.5 mV) in limb leads (LQRSV) on the athlete's electrocardiogram (ECG) may reflect an underlying cardiomyopathy, mostly arrhythmogenic cardiomyopathy (ACM) or non-ischaemic left ventricular scar (NILVS). We studied the prevalence and clinical meaning of isolated LQRSV in a large cohort of competitive athletes. Methods and results: The index group included 2229 Italian competitive athletes [median age 18 years (16–25), 67% males, 97% Caucasian] without major ECG abnormalities at pre-participation screening. Three control groups included Black athletes ( N = 1115), general population ( N = 1115), and patients with ACM or NILVS ( N = 58). Echocardiogram was performed in all athletes with isolated LQRSV and cardiac magnetic resonance (CMR) in those with ventricular arrhythmias or echocardiographic abnormalities. The isolated LQRSV pattern was found in 1.1% index athletes and was associated with increasing age (median age 28 vs. 18 years; P < 0.001), elite status (71% vs. 34%; P < 0.001), body surface area, and body mass index but not with sex, type of sport, and echocardiographic left ventricular mass. The prevalence of isolated LQRSV was 0.2% in Black athletes and 0.3% in young individuals from the general population. Cardiomyopathy patients had a significantly greater prevalence of isolated LQRSV (12%) than index athletes, Black athletes, and general population. Five index athletes with isolated LQSRV and exercise-induced ventricular arrhythmias underwent CMR showing biventricular ACM in 1 and idiopathic NILVS in 1. Conclusions: Unlike cardiomyopathy patients, the ECG pattern of isolated LQRSV was rarely observed in athletes. This ECG sign should prompt clinical work-up for exclusion of an underlying cardiomyopathy. Graphical Abstract: