Avaliação longitudinal do eletrocardiograma do atleta jovem

Abstract

Background: Competitive sports practice is associated with an increase in the risk of sudden cardiac death in athletes with a silent preexistent non diagnosed cardiovascular condition. Aiming to tackle this real threat, a number of preparticipation cardiovascular protocols have been implemented with varying results. One of the suggested strategies uses the resting electrocardiogram as a screening tool. However, the definition of abnormal findings in the young athlete is still debated, and there is lack of consensus in the literature. Objectives: report electrocardiographic patterns of Brazilian soccer players; evaluate current accepted normal electrocardiographic patterns in the young athlete and to assess its longitudinal variability overtime, from adolescence to early adulthood; Methods: Between 2009 and 2019, 487 male athletes (14,1± 2,0 years-old) participated and their 1503 electrocardiograms were analyzed according to the International Recommendations Criteria (2017). The athletes that competed for a minimum of two consecutive seasons were included in the study. All athletes were evaluated at admission and also before the onset of every new season of competition. Medical evaluation consisted of an individual medical assessment and resting electrocardiogram. In the present study we reviewed all electrocardiograms and clinical charts of these athletes. Results: T-wave inversion was found in 65 (13,3%) athletes, 14,7% (5/34) pretos, 14,4% (44/306) pardos, and 10,9% (16/147) brancos. TWI proportion in electrocardiograms was significantly higher in pretos (p=0,003). Age was inversely correlated to TWI in V1-V3 (p=0,01) and directly correlated when occurring in inferior leads (p<0,001). Twenty two athletes (4,5%) had and abnormal electrocardiogram, and 10 of them (2,1%) had two or more borderline findings. From the evolutionary point of view, the non-deep T-wave inversions (<2,0mm) in inferior leads completely disappeared in 7 of 7 athletes, while it was also observed in 3 of 10 athletes with T-wave inversion in the lateral leads. On the second study, after an interval of 4 years between medical evaluations, unprecedented marked inferolateral repolarization alterations were observed in a former asymptomatic athlete, with no history of heart disease. Conclusions: Both studies reveal the dynamic electrocardiographic patterns likely to occur during adolescence thru early adulthood and suggest that electrocardiogram must be periodically repeated in athletes during this phase.