Left ventricular geometry correlates with early repolarization pattern in adolescent athletes

Some forms of early ECG repolarization QRS pattern (ERp) with J-point elevation of 0.1mV in two contiguous inferior and/or lateral leads with or without ST elevation are potentially associated with a higher arrhythmic risk in adults. We assessed the prevalence of ERp among non-professional adolescent athletes and correlated it with age, sex, ethnicity and structural and electric cardiac parameters. We retrospectively analyzed 414 ECGs obtained from young athletes referred to our centre from 2006 to 2017. We found ERp in 22% of cases. In the ERp group, we found a greater percentage of blacks, a higher systolic blood pressure, and lower heart rate (HR) compared with the group without ERp. This pattern was less frequent in female athletes. In athletes with ERp, the occurrence of ventricular ectopic beats was less frequent and QRS duration was shorter. They also exhibited greater i) ECG-based left ventricular hypertrophy (LVH), ii) left ventricular mass, and iii) relative wall thickness (RWT), suggesting a tendency to concentric geometry. At logistic regression analysis, we found that HR (OR 0.98 [0.96-0.99] p= 0.013), QRS duration (OR 0.96 [0.94-0.99], p= 0.003), LVH (OR 1.09 [1.05-1.12], p< 0.001), and RWT (OR 1.08 [1.01-1.16] p= 0.032) were significant predictors of ERp incidence. ERp is quite common in adolescent athletes and correlates with concentric LV remodeling. Specific clinical and ECG-findings related to training such as lower HR, LVH, and QRS duration are also predictors of ERp. In adolescent non-professional athletes, ERp is a benign finding associated with some structural and electric cardiac modifications induced by training.