Comparison of the Stanford ECG Left Atrial Criteria With the International ECG Criteria for Sports Screening

Clin J Sport Med. 2021 Jul 1;31(4):388-391. doi: 10.1097/JSM.0000000000000766.


Objective: Because the International left atrial enlargement electrocardiographic (ECG) screening criteria (ECG-LAE) for athletes are rarely fulfilled in young athletes, we compared it with evidence-based criteria from a recent clinical outcome study of ECG left atrial abnormality (ECG-LAA).

Design: Retrospective analyses.

Setting: Routine preparticipation ECG screening in California.

Participants: Four thousand four hundred thirty-eight young individuals (18.5 ± 5.4 years, 40% women).

Assessment of risk factors: The International criteria for ECG-LAE were applied: prolonged P wave duration of ≥120 ms in leads I or II AND negative portion of ≥1 mm in depth in lead V1. This was compared with Stanford criteria for ECG-LAA: prolonged P wave duration of ≥140 ms odds ratio (OR) negative portion in V1 and V2 greater than 1 mm.

Main outcome measures: Differences in the classification of abnormal ECGs between the 2 criteria applied to the same population of young athletes.

Results: Only 33 (0.7%) of our subjects fulfilled the International criteria for ECG-LAE while 110 (2.5%) fulfilled the ECG-LAA criteria. Adding our new ECG-LAA criterion and considering it a major criterion raised the abnormal ECG prevalence and athletes referred for further evaluation from 2.9% to 4.4%.

Conclusions: The Stanford evidence-based criterion for ECG-LAA incorporating V2 and replacing "or" for "and" regarding P wave duration increased the yield of abnormal classification for P waves. Future follow-up studies are needed to confirm that this new criterion should be included in future ECG screening consensus documents.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Athletes
  • Cardiomegaly / diagnostic imaging*
  • Electrocardiography*
  • Female
  • Heart Atria* / physiopathology
  • Humans
  • Male
  • Mass Screening
  • Retrospective Studies
  • Sports*
  • Young Adult