Prevalence of electrocardiographic anomalies in young individuals: relevance to a nationwide cardiac screening program

Abstract

Objectives: This study sought to investigate the prevalence of potentially abnormal electrocardiographic (ECG) patterns in young individuals to assess the implications for a nationwide screening program for conditions causing sudden cardiac death (SCD).

Background: The Italian experience suggests that pre-participation screening with ECG reduces the incidence of SCD in athletes. However, the majority of SCDs occur in nonathletes. In the United Kingdom, screening for cardiac disorders is confined to symptomatic individuals or those with a family history of inherited cardiac conditions or premature cardiac death.

Methods: Between 2008 and 2012, 7,764 nonathletes ages 14 to 35 years underwent ECG screening. Electrocardiograms were analyzed for group 1 (training-related) and group 2 (potentially pathological) patterns presented in the 2010 European Society of Cardiology position paper, which advocates further evaluation for individuals with group 2 ECG patterns. Results were compared with 4,081 athletes.

Results: Group 1 patterns occurred in 49.1% of nonathletes and 87.4% of athletes (p < 0.001). Group 2 patterns occurred in 21.8% of nonathletes and 33% of athletes (p < 0.001). In nonathletes, QTc interval abnormalities comprised the majority (52%) of group 2 changes, whereas T-wave inversions constituted 11%. Male sex and African/Afro-Caribbean ethnicity demonstrated the strongest association with group 2 ECG patterns.

Conclusions: The study demonstrates that 1 in 5 young people have group 2 ECG patterns. The low incidence of SCD in young people suggests that in most instances such patterns are non-specific. These findings have significant implications on the feasibility and cost-effectiveness of nationwide screening programs for cardiovascular disease in young nonathletes and athletes alike, on the basis of current guidelines.

Keywords: electrocardiogram; ethnicity; pre-participation screening; sudden cardiac death.