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, 4 (4), 432-40

Early Repolarization Pattern in Competitive Athletes: Clinical Correlates and the Effects of Exercise Training

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Early Repolarization Pattern in Competitive Athletes: Clinical Correlates and the Effects of Exercise Training

Peter A Noseworthy et al. Circ Arrhythm Electrophysiol.

Abstract

Background: Inferior lead early repolarization pattern (ERP) recently has been associated with sudden cardiac death. Although ERP is common among athletes, prevalence, ECG lead distribution, clinical characteristics, and effects of physical training remain uncertain. We sought to examine the nonanterior ERP in competitive athletes.

Methods and results: ERP was assessed in a cross-sectional cohort of collegiate athletes (n = 879). The relationship between ERP and cardiac structure were then examined in a longitudinal subgroup (n = 146) before and after a 90-day period of exercise training. ERP was defined as J-point elevation ≥ 0.1 mV in at least 2 leads within a nonanterior territory (inferior [II, III, aVF] or lateral territory [I, aVL, V4-V6]). Nonanterior ERP was present in 25.1% (221/879) of athletes, including the inferior subtype in 3.8% (33/879). Exercise training led to significant increases in the prevalence of ERP and the inferior subtype, but there were no associations between ERP and echocardiographic measures of left ventricular remodeling. In a multivariable model, ERP was associated with black race (odds ratio [OR], 5.84; 95% CI, 3.54 to 9.61; P < 0.001), increased QRS voltage (OR, 2.08; 95% CI, 1.71 to 2.52; P < 0.001), and slower heart rate (OR, 1.54; 95% CI, 1.26 to 1.87; P < 0.001).

Conclusions: Nonanterior ERP, including the inferior subtype, is common and has strong clinical associations among competitive athletes. The finding of increased ERP prevalence after intense physical training establishes a strong association between exercise and ERP.

Conflict of interest statement

Conflict of Interest Disclosures: None

Figures

Figure 1
Figure 1
ERP morphologic classifications: (a) marked ERP (>0.2mV) with discrete J-point and ascending ST segment, (b) discrete notched J-point and ascending ST segment, (c) notched J-point and ascending ST segment, (d) slurred J-point and ascending ST segment, (e) discrete J-point and ascending ST segment (f) slurred J-point and horizontal ST segment.
Figure 2
Figure 2
Prevalence and ECG lead distribution of non-anterior ERP among competitive intercollegiate athletes (n=879).
Figure 3
Figure 3
Prevalence of ERP and the inferior ERP subtype as function of sport type among competitive intercollegiate athletes (n=879).
Figure 4
Figure 4
Lateral (V4-6) and inferior (II, III, aVF) 12-lead ECG leads in a collegiate rower before (A.) and after (B.) 90-days of team-based exercise training demonstrating the development of non-anterior early repolarization pattern (arrows).

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