A key goal of FIFA and F-MARC is prevention of sudden cardiac death during football. Despite the high visibility of these tragic events and pressure from sporting and medical bodies to mandate full cardiovascular screening prior to participation, players are still dying on the field. FIFA requires all participates in events they sponsor to have had a complete cardiovascular evaluation prior to the even. One of the required tests is the simple resting electrocardiogram. Part of the problem is that clinical norms are based on a largely non-athletic, and racially homogenous, population.
Dozens of scientific papers have described normal variants of the resting ECG in athletes, but the wide distribution of racial and ethic diversity in the modern game means that clinicians may not have the best normative values to draw a valid conclusion. The purpose of Bohm et al. was to evaluate ECG abnormalities in a large sample of elite football players. To do this, they gathered ECGs from 566 elite male football players (a small number, 57, of African origin) who were all over 16 years of age (average age=20.9 ± 5.3 years; BMI=22.9 ± 1.7 kg·m−2, years training=13.8 ± 4.7 years). The resting ECGs were analysed and classified according to the 2010 European Society of Cardiology (ESC) criteria and according to the classification system of Pelliccia et al. (2000) to assess the impact of the new ESC-approach might have on diagnostic yield. Using Pelliccia’s criteria, 52.5% of these players had mildly abnormal ECG patterns and 12% were classified as distinctly abnormal ECG patterns. According to the classification of the ESC, however, 33.7% showed ‘uncommon ECG patterns’. The most frequent finding was a short-QT interval (41.9%), then a shortened PR-interval (19.9%).
When assessed with a QTc cut-off-point of 340 ms (instead of 360 ms), only 22.2% players had ‘uncommon ECG patterns’. Variants on resting ECG amongst elite football players are common and false positive results, based on non-athletic populations. Adjusting the ESC criteria by adapting proposed time limits for the ECG (e.g. QTc as suggested above as well as others) should further reduce the rate of false-positive results.