Several electrocardiographic changes can be seen in athletes which represent physiologic adaptations. These findings do not need to be evaluated further in the asymptomatic 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 are considered normal adaptations in athletes:
(1) sinus bradycardia with heart rate >= 30 beats per minute
(2) sinus arrhythmias
(3) ectopic atrial rhythm
(4) junctional escape ehythm
(5) PR interval > 200 milliseconds (first degree AV block)
(6) Mobitz type I (Wenchebach) second-degree AV block
(7) incomplete right bundle branch block (RBBB)
(8) isolated QRS voltage criteria for left ventricular hypertrophy, with absence of any non-voltage criteria
(9) early repolarization
(10) convex ("domed") ST segment elevations combined with T-wave inversion in leads V1 to V4 of Black athletes
where:
• Non-voltage criteria for left ventricular hypertrophy include left atrial enlargement, left axis deviation, ST segment depression, pathological Q waves and/or T-wave inversion.
