Several electrocardiographic changes can be seen in athletes which should alert a physician to the presence of an underlying cardiomyopathy. These findings need to be evaluated further especially if the patient is symptomatic athlete. The Seattle criteria are from a meeting of the American Medical Society for Sports Medicine, FIFA and other organizations that met in Seattle in 2012.

ECG changes that may be associated with an underlying cardiomyopathy:

(1) T wave inversion (> 1 mm in 2 or more leads from V2, V3, V4, V5, V6, aVF, I, II, or aVL, excludes V1, III and aVR)

(2) ST segment depression (>= 0.5 mm in 2 or more leads)

(3) pathologic Q waves (> 3 mm in depth or 30 ms in duration in >= 2 leads, excluding III and aVR)

(4) complete left bundle branch block (LBBB, QRS >= 120 ms, largely negative QRS complex in V1 as QS or rS; upright monophasic R wave in leads I and V6)

(5) intraventricular conduction delay (QRS duration >= 140 ms)

(6) left axis deviation (minus 30 to minus 90 degrees)

(7) left atrial enlargement (prolonged P wave duration in leads I or II > 120 ms; negative portion of the P wave >= 1 mm in depth and >= 40 ms for duration in lead V1)

(8) right ventricular hypertrophy pattern (R-V1 plus S-V5 > 10.5 mm AND right axis deviation > 120°C

(9) premature ventricular contractions (PVCs, 2 or more in a 10 second tracing)

(10) ventricular arrhythmias (including couplets, triplets and non-sustained ventricular tachycardia)



• The last 2 ECG changes can also be seen in electrical disorders.

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