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Heart Rhythm. 2014 Nov;11(11):1974-82. doi: 10.1016/j.hrthm.2014.07.042. Epub 2014 Aug 1.

Benign clinical significance of J-wave pattern (early repolarization) in highly trained athletes.

Author information

1
Institute of Sport Medicine and Science, Italian National Olympic Committee, Rome, Italy.
2
Institute of Sport Medicine and Science, Italian National Olympic Committee, Rome, Italy. Electronic address: ant.pelliccia@libero.it.
3
Department of Experimental Medicine, University La Sapienza, Rome, Italy.
4
Giorgio Castelli Onluss Foundation, Rome, Italy.
5
Tufts Medical Center, Boston, Massachusetts.
6
Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis. Minnesota.

Abstract

BACKGROUND:

J wave/QRS slurring (early repolarization) on 12-lead ECG has been associated with increased risk for ventricular fibrillation in the absence of cardiovascular (CV) disease.

OBJECTIVE:

The purpose of this study was to assess the prevalence and clinical significance of J wave/QRS slurring in a large population of competitive athletes.

METHODS:

Seven hundred four athletes (436 males [62%], age 25 ± 5 years) free of CV disease who had engaged in 30 different sports were examined. Serial clinical, ECG, and echocardiographic evaluations were available over 1 to 18 years of follow-up (mean 6 ± 4 years).

RESULTS:

J wave was found in 102 athletes (14%) and was associated with QRS slurring in 32 (4%). It was found most commonly in anterior, lateral, and inferior leads (n = 73 [72%]), occasionally in lateral leads (n = 26 [25%]), and rarely in inferior leads (n = 3 [3%]). Most of 102 athletes (n = 86 [84%]) also showed ST-segment elevation. J wave/QRS slurring was associated with other training-related ECG changes (ie, increased R/S-wave voltages in 76%) and left ventricular (LV) morphologic remodeling (LV mass 199 ± 48 g vs 188 ± 56 g, P <.05). During follow-up, no athlete with J wave experienced cardiac event or ventricular tachyarrhythmias, or developed structural CV disease.

CONCLUSION:

In athletes, early repolarization pattern usually is associated with other ECG changes, such as increased QRS voltages and ST-segment elevation, as well as LV remodeling, suggesting that it likely represents another benign expression of the physiologic athlete's heart. J wave (early repolarization) is common in highly trained athletes and does not convey risk for adverse cardiac events, including sudden death or tachyarrhythmias.

KEYWORDS:

Arrhythmia; Athletes; Early repolarization; Electrocardiography; J wave; Sudden death

PMID:
25092400
DOI:
10.1016/j.hrthm.2014.07.042
[Indexed for MEDLINE]
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