Objectives-To evaluate the spectrum of electrocardiographic (ECG) changes i
n 1000 junior (18 or under) elite athletes.
Methods-A total of 1000 (73% male) junior elite athletes (mean (SD) age 15.
7 (1.4) years (range 14-18); mean (SD) body surface area 1.73 (0.17) m(2) (
range 1.09-2.25)) and 300 non-athletic controls matched for gender, age, an
d body surface area had a 12 lead ECG examination.
Results-Athletes had a significantly higher prevalence of sinus bradycardia
(80% v 19%; p<0.0001) and sinus arrhythmia (52% v 9%; p<0.0001) than non-a
thletes. The PR interval, QRS, and QT duration were more prolonged in athle
tes than non-athletes (153 (20) v 140 (18) milliseconds (p<0.0001), 92 (12)
v 89 (7) milliseconds (p<0.0001), and 391 (27) v 379 (29) milliseconds (p
= 0.002) respectively). The Sokolow voltage criterion for left ventricular
hypertrophy (LVH) and the Romhilt-Estes points score for LVH was more commo
n in athletes (45% v 23% (p<0.0001) and 10% v 0% (p<0.0001) respectively),
as were criteria far left and right atrial enlargement (14% v 1.2% and 16%
v 2% respectively). None of the athletes with voltage criteria for LVH had
left axis deviation, ST segment depression, deep T wave inversion, or patho
logical Q waves. ST segment elevation was more common in athletes than non-
athletes (43% v 24%; p<0.0001). Minor T wave inversion (less than -0.2 mV)
in V2 and V3 was present in 4% of athletes and non-athletes. Minor T wave i
nversion elsewhere was absent in non-athletes and present in 0.4% of athlet
es.
Conclusions-ECG changes in junior elite athletes are not dissimilar to thos
e in senior athletes. Isolated Sokolow voltage criterion for LVH is common;
however, associated abnormalities that indicate pathological hypertrophy a
re absent. Minor T wave inversions in leads other than V2 and V3 may be pre
sent in athletes and non-athletes less than 16 but should be an indication
for further investigation in older athletes.