Electrocardiographic characteristics of pediatric and adolescent football players

Abstract

Electrocardiographic characteristics of children and adolescents present differences compared to adults. The aim of our work was to study electrocardiograms (ECGs) of football male players from childhood to late adolescence and examine if the ECG parameters are influenced by systematic exercise. One thousand fifty-four football players participated and formed four groups. Group A included 89 players aged 5-7 years, group B 353 players aged 8-11 years, group C consisted of 355 football players 12-15 yearsold and group D of 257 players with 16-18 years of age. All participants underwent preparticipation screening, including 12-lead surface ECG. Heart rate (HR), PR, RR, QRS, QT, QTc intervals, QT dispersion (QTdisp) and QRS axis were calculated. All ECGs were evaluated according to the current preparticipation cardiac screening guidelines, that refer to athletes aged 12-35 years and do not include pediatric players. Eleven percent of the participants presented an ECG finding. Group D obtained the lowest values of HR, QTc and the highest of PR, RR, QRS, QT intervals and QTdisp, whereas no differences in QRS axis were reported. Incomplete Right Bandle Branch Block (RBBB) was the most frequent ECG peculiarity, detected in 7.3% of the participants. Years of training were statistically significantly correlated to HR, PR, RR, QRS and QT intervals. In conclusion, guidelines for ECG interpretation of athletes in childhood, early and late adolescence are needed.

Keywords

Exercise / Children / Adolescents / Electrocardiogram / Soccer

References

1	J.P. Chaput, J. Willumsen, F. Bull, et al..
220	WHO guidelines on physical activity and sedentary behaviour for children and adolescents aged 5-17 years: summary of the evidence. Int J Behav Nutr Phys Activ, 17 (1) (2020), p. 141, 10.1186/s12966-020-01037-z.
2.	R. Guthold, G.A. Stevens, L.M. Riley, F.C. Bull. Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1.6 million participants. Lancet Child Adolesc Health, 4 (1) (2020), pp. 23-35, 10.1016/S2352-4642(19)30323-2.
3	B.J. Maron, P.D. Thompson, J.C. Puffer, et al.. Cardiovascular preparticipation screening of competitive athletes. A statement for health professionals from the Sudden Death Committee. Cardiovascular preparticipation screening of competitive athletes. A statement for health professionals from the Sudden Death Committee (clinical cardiology) andCongenital Cardiac Defects Committee (cardiovascular disease in the young), American Heart Association. Circulation, 94 (4) (1996), pp. 850-856, 10.1161/01.cir.94.4.850.
4.	B.J. Petek, A.L. Baggish. Pre-participation cardiovascular screening in young competitive athletes. Curr Emerg Hosp Med Rep, 8 (3) (2020), pp. 77-89, 10.1007/s40138-020-00214-5.
5	A. Davignon, P. Rautaharju, E. Boisselle, F. Soumis, M. Mégélas, A. Choquette. Normal ECG standards for infants and children. Pediatr Cardiol, 1 (1980), pp. 123-131, 10.1007/BF02083144.
6.	P.R. Rijnbeek, M. Witsenburg, E. Schrama, J. Hess, J.A. Kors.New normal limits for the pediatric electrocardiogram. Eur Heart J, 22 (8)(2001), pp. 702-711, 10.1053/euhj.2000.2399.
7.	M. Yoshinaga, M. Iwamoto, H. Horigome, et al.. Standard values. Standard values and characteristics of electrocardiographic findings in children and adolescents. Circ J, 82 (3) (2018), pp. 831-839, 10.1253/circj.CJ-17-0735.
8.	A. Bratincsák, C. Kimata, B.N. Limm-Chan, K.P. Vincent, M.R. Williams, J.C. Perry. Electrocardiogram standards for children and young adults using z-scores. Circ Arrhythm Electrophysiol, 13 (8) (2020), Article e008253, 10.1161/CIRCEP.119.008253.
9	M. Santini, S.A. Di Fusco, F. Colivicchi, A. Gargaro. Electrocardiographic characteristics, anthropometric features,cardiovascular risk factors in a large cohort of adolescents. Europace, 20 (11) (2018), pp. 1833-1840, 10.1093/europace/euy073.
10	D.F. Dickinson.The normal ECG in childhood and adolescence. Heart, 91 (12)(2005), pp. 1626-1630, 10.1136/hrt.2004.057307.
11	H. Pentikäinen, K. Toivo, S. Kokko, et al.. Resting electrocardiogram. Resting electrocardiogram and blood pressure in young endurance and nonendurance athletes and nonathletes. J Athl Train, 56 (5) (2021), pp. 484-490, 10.4085/78-20.
12	G. McClean, N.R. Riding, C.L. Ardern, et al.. Electrical. Electrical and structural adaptations of the pediatric athlete's heart: a systematic review with meta-analysis. Br J Sports Med, 52 (4) (2018), p. 230, 10.1136/bjsports-2016-097052.
13	A.W. Bjerring, H.E. Landgraff, T.M. Stokke, et al.. The developing athlete's heart: a cohort study in young athletes transitioning through adolescence. Eur J Prev Cardiol. The developing athlete's heart: a cohort study in young athletes transitioning through adolescence. Eur J Prev Cardiol, 26 (18) (2019), pp. 2001-2008, 10.1177/2047487319862061.
14	F.M.Di Paolo, C. Schmied, Y.A. Zerguini, et al.. The athlete's heart in adolescent Africans: an electrocardiographic and echocardiographic study. J Am Coll Cardiol, 59 (11)(2012), pp. 1029-1036, 10.1016/j.jacc.2011.12.008.
15.	A. Malhotra, D. Oxborough, P. Rao, et al.. Defining the normal spectrum of electrocardiographic. Defining the normal spectrum of electrocardiographic and left ventricular adaptations in mixed-race male adolescent soccer players. Circulation, 143 (1) (2021), pp. 94-96, 10.1161/CIRCULATIONAHA.120.049740.
16	S. Sharma, J.A. Drezner, A. Baggish, et al.. International recommendations for electrocardiographic interpretation in athletes. Eur Heart J. International recommendations for electrocardiographic interpretation in athletes. Eur Heart J, 39 (16) (2018), pp. 1466-1480, 10.1093/eurheartj/ehw631.
17	J.A. Drezner, S. Sharma, A. Baggish, et al.. International criteria for electrocardiographic interpretation in athletes: consensus statement. Br J Sports Med. International criteria for electrocardiographic interpretation in athletes: consensus statement. Br J Sports Med, 51 (9) (2017), pp. 704-731, 10.1136/bjsports-2016-097331.
18	P.W. Macfarlane, J. Kennedy. Automated ECG Interpretation—a brief history from high expectations to deepest networks. Heart (Lond), 2 (2021), pp. 433-448, 10.3390/hearts2040034.
19.	H. Bazett. An analysis of the time -relations of the electrocardiograms. Heart, 7 (1920), pp. 353-370, 10.1111/j.1542-474X.1997.tb00325.x.
20.	P.D. Higham, R.W. Campbell. QT dispersion. Br Heart J, 71 (6) (1994), pp. 508-510, 10.1136/hrt.71.6.508.
21	J.T. Flynn, B.E. Falkner. New clinical practice guideline for the management of high blood pressure in children and adolescents. Hypertension, 70 (4) (2017), pp. 683-686, 10.1161/HYPERTENSIONAHA.117.10050.
22	E. Cavarretta, L. Sciarra, G. Biondi-Zoccai,et al.. Age-related electrocardiographic characteristics of male junior soccer athletes. Front Cardiovasc Med, 8 (2022), Article 784170, 10.3389/fcvm.2021.784170.
23.	L.M. Harteveld, I. Nederend, A.D.J. Ten Harkel, et al.. Maturation of the cardiac autonomic nervous system activity in children. Maturation of the cardiac autonomic nervous system activity in children and adolescents. J Am Heart Assoc, 10 (4) (2021), Article e017405, 10.1161/JAHA.120.017405.
24.	G.E. Pieles, R. Oberhoffer. The assessment of the pediatric Athlete. J Cardiovasc Transl Res, 13 (3) (2020), pp. 306-312, 10.1007/s12265-020-10005-8.
25	G.Z. Sun, Y. Li, X.H. Zhou, et al.. Association between obesity and ECG variables in children and adolescents: a cross-sectional study. Exp Ther Med, 6 (6)(2013), pp. 1455-1462, 10.3892/etm.2013.1337.
26	A. Benatar, A. Feenstra. QT correction methods in infants and children: effects of age and gender. Ann Noninvasive Electrocardiol, 20 (2) (2015), pp. 119-125, 10.1111/anec.12200.
27	M. Turkmen, I. Barutcu, A.M. Esen, et al.. Assessment of QT interval duration. Assessment of QT interval duration and dispersion in athlete's heart. J Int Med Res, 32 (6) (2004), pp. 626-632, 10.1177/147323000403200607.
28	F. Triposkiadis, S. Ghiokas, I. Skoularigis, A. Kotsakis, I. Giannakoulis, V. Thanopoulos. Cardiac adaptation to intensive training in prepubertal swimmers. Eur J Clin Invest, 32 (1) (2002), pp. 16-23, 10.1046/j.0014-2972.2001.00939.x.
29	M. Malik, V.N. Batchvarov. Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol, 36 (6) (2000), pp. 1749-1766, 10.1016/s0735-1097(00)00962-1.
30.	A. Akkuş, M. Belviranli, F. Şap, N. Okudan. Assessment of structure, function,rhythm of the heart with echocardiography and electrocardiography in adolescent swimmers. Pediatr Cardiol, 42 (1) (2021), pp. 182-188, 10.1007/s00246-020-02469-x.
31	V. Stoičkov, D. Radovanović, M. Deljanin-Ilić, et al.. Sport-related differences in QT dispersion. Sport-related differences in QT dispersion and echocardiographic parameters in male athletes. Sci Rep, 13 (1) (2023), p. 6770, 10.1038/s41598-023-33957-8.
32	J.H. Kim, P.A. Noseworthy, D. McCarty,et al.. Significance of electrocardiographic right bundle branch block in trained athletes. Am J Cardiol, 107 (7)(2011), pp. 1083-1089, 10.1016/j.amjcard.2010.11.037.
33.	A. Pelliccia, S. Sharma, S. Gati, et al.. 220 ESC guidelines on sports cardiology. 220 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease[published correction appears in Eur Heart J. 2021;42(5):548-549]. Eur Heart J, 42 (1) (2021), pp. 17-96, 10.1093/eurheartj/ehaa605.
34	G. Halasz, M. Cattaneo, M. Piepoli, et al.. Early Repolarization in pediatric athletes: a dynamic electrocardiographic pattern with benign prognosis. J Am Heart Assoc. Early Repolarization in pediatric athletes: a dynamic electrocardiographic pattern with benign prognosis. J Am Heart Assoc, 10 (16) (2021), Article e020776, 10.1161/JAHA.121.020776.
35	G.L. Ragazzoni, L. Cavigli, E. Cavarretta, et al.. How to evaluate resting ECG. How to evaluate resting ECG and imaging in children practising sport: a critical review and proposal of an algorithm for ECG interpretation. Eur J Prev Cardiol, 30 (5) (2023), pp. 375-383, 10.1093/eurjpc/zwac218