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



• 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.

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