Justification of an introductory electrocardiogram teaching mnemonic by demonstration of its prognostic value

Normal computerized Q wave measurements in healthy young athletes

BACKGROUND

Recent Expert consensus statements have sought to decrease false positive rates of electrocardiographic abnormalities requiring further evaluation when screening young athletes. These statements are largely based on traditional ECG patterns and have not considered computerized measurements.

OBJECTIVE

To define the normal limits for Q wave measurements from the digitally recorded ECGs of healthy young athletes.

METHODS

All athletes were categorized by sex and level of participation (high school, college, and professional), and underwent screening ECGs with routine pre-participation physicals, which were electronically captured and analyzed. Q wave amplitude, area and duration were recorded for athletes with Q wave amplitudes greater than 0.5mm at standard paper amplitude display (1mV/10mm). ANOVA analyses were performed to determine differences these parameters among all groups. A positive ECG was defined by our Stanford Computerized Criteria as exceeding the 99th percentile for Q wave area in 2 or more leads. Proportions testing was used to compare the Seattle Conference Q wave criteria with our data-driven criteria.

RESULTS

2073 athletes in total were screened. Significant differences in Q wave amplitude, duration and area were identified both by sex and level of participation. When applying our Stanford Computerized Criteria and the Seattle criteria to our cohort, two largely different groups of athletes are identified as having abnormal Q waves.

CONCLUSION

Computer analysis of athletes' ECGs should be included in future studies that have greater numbers, more diversity and adequate end points.