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Clinical relevance of some electrocardiogram (ECG) findings may remain unclear, and uncommon findings suggesting underlying disease can still appear in healthy athletes without supportive pathology. This poses dilemmas for clinicians judging sports eligibility and supporting athletes’ decisions about future competition. Current guidance outlines differential diagnosis between athlete’s heart and cardiac disease, but ECG anomalies of uncertain significance—test scope and follow-up needs—require clearer, evidence-based direction for asymptomatic athletes.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/abnormal-electrocardiogram-findings-in-athletes-a-consensus-statement-of-the-european-association-of-preventive-cardiology-of-the-european-society-of-cardiology/455970/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/abnormal-electrocardiogram-findings-in-athletes-a-consensus-statement-of-the-european-association-of-preventive-cardiology-of-the-european-society-of-cardiology/455970.png","ImageObject",300,407,{"name":92,"@type":93},"วิน","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-08","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why can ECG interpretation be difficult in athletes?","Question",{"text":113,"@type":114},"Athletes often have physiological adaptations that can mimic pathological ECG patterns, so distinguishing benign changes from disease is challenging.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What dilemmas do uncertain ECG findings create for clinicians?",{"text":118,"@type":114},"Uncertain findings complicate decisions about sports eligibility and affect how clinicians guide athletes on whether to continue competitive participation.",{"name":120,"@type":111,"acceptedAnswer":121},"How does the document recommend approaching ECG abnormalities of uncertain significance?",{"text":122,"@type":114},"Use a probabilistic strategy to refine pre-test probability; when first-line tests do not clarify significance, proceed to second-line investigations and consider periodic re-evaluation when uncertainty persists.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},455970,1791035739,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":146,"preview_page_count":4},2336475104736,"https://ap-avatar.wpscdn.com/avatar/22000c4c5e0e5b17e70?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786591360781797222","European Heart Journal (2026) 47, 152–169 [https://doi.org/10.1093/eurheartj/ehaf646](https://doi.org/10.1093/eurheartj/ehaf646)  \nSPECIAL ARTICLE  \nEpidemiology, prevention, and health care policies  \nAbnormal electrocardiogram findingsin athletes  \nA consensus statement of the European Association of Preventive Cardiology of the European Society of Cardiology  \nGherardo Finocchiaro  1, Alessandro Zorzi  2, Mark Abela  3,4, Aaron Baggish5, Silvia Castelletti  6, Elena Cavarretta  7, Guido Claessen8,  \nDomenico Corrado  2, Maria Sanz de la Garza9, Sabiha Gati10,  \nViviana Maestrini  11, Aneil Malhotra12, Josef Niebauer13, David Niederseer  14, Michael Papadakis1, Antonio Pelliccia  11, Sanjay Sharma  1,*,  \nand Flavio D’Ascenzi15  \n1Cardiovascular and Genomic Research Institute, City St George’s, University of London, Cranmer Terrace, London SW17 0RE, UK; 2Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy; 3University of Malta, Msida, MSD2090, Malta; 4Department of Cardiology, Mater Dei Hospital, Msida, Malta; 5Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland; 6Dipartimento di Cardiologia, IRCCS Istituto Auxologico Italiano, Milan, Italy; 7Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy; 8Faculty of Medicine and Life Sciences, Biomedical Research Institute, LCRC, UHasselt, Hasselt, Belgium; 9Cardiovascular Institute, Hospital Clínic de Barcelona, Barcelona, Spain; 10School of Medicine, Imperial College London, London, UK; 11Institute of Sport Medicine and Science, National Italian Olympic Committee, Rome, Italy; 12Institute of Sport, Manchester Metropolitan University, Manchester, UK; 13Institute of Sports Medicine, Prevention and Rehabilitation, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria; 14Hochgebirgsklinik Davos, Medicine Campus Davos, Davos, Switzerland; and 15Department of Medical Biotechnologies, Sports Cardiology and Rehab Unit, University of Siena, Siena, Italy  \nOnline publish-ahead-of-print 25 September 2025  \nAbstract  \nAthletes commonly exhibit a series of electrical, structural, and functional physiological changes which may overlap with cardiac pathology. The last two decades have witnessed a progressive improvement in understanding what can be considered benign for athletes and what may be deemed as potentially pathological and require further investigations. However, diagnostic uncertainties in the cardiac assessment of athletes are often encountered. In particular, the clinical significance of some electrocardiogram (ECG) findings may be uncertain. While uncommon and suggestive of an underlying cardiac condition, they may be identified among healthy athletes without additional pathological findings to support a unifying clinical diagnosis. This creates significant dilemmas for clinicians charged with determining sports eligibility and those who have the responsibility to help athletes in the decision-making process regarding future competitive sports participation. Current guidelines, recommendations, and position papers provide a roadmap for the differential diagnosis between ‘athlete’s heart’ and cardiac disease. However, managing ECG findings of uncertain clinical significance, especially when initial diagnostic evaluation reveals no supportive signs of pathology, has received comparatively less attention, in particular, the type of cardiac investigations, the extent of diagnostic work-up and the need for follow-up require clarification. This document aims to provide guidance based on published evidence and expert opinions to assist in the clinical decision-making regarding ECG anomalies that are common sources of uncertainty when managing asymptomatic athletes.  \n* Corresponding author. Email: [sasharma@sgul.ac.uk](sasharma@sgul.ac.uk)  \n© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. ","cbCair3IMAPL3yQs","https://ap.wps.com/l/cbCair3IMAPL3yQs","pdf",4375014,18,"English","# Abstract\n# Keywords\n# Introduction\n## Epidemiology and sudden cardiac death risk\n## ECG interpretation challenges in athletes","[{\"question\":\"Why can ECG interpretation be difficult in athletes?\",\"answer\":\"Athletes often have physiological adaptations that can mimic pathological ECG patterns, so distinguishing benign changes from disease is challenging.\"},{\"question\":\"What dilemmas do uncertain ECG findings create for clinicians?\",\"answer\":\"Uncertain findings complicate decisions about sports eligibility and affect how clinicians guide athletes on whether to continue competitive participation.\"},{\"question\":\"How does the document recommend approaching ECG abnormalities of uncertain significance?\",\"answer\":\"Use a probabilistic strategy to refine pre-test probability; when first-line tests do not clarify significance, proceed to second-line investigations and consider periodic re-evaluation when uncertainty persists.\"}]","Abnormal electrocardiogram findings in athletes - A consensus statement of the European Association of Preventive Cardiology of the European Society of Cardiology | PDF",1790744815,45]