Gender-Related Electrocardiographic Changes in Athletes

Objectives: To assess gender differences in training-related electrocardiographic (ECG) patterns of athletes, highlighting the importance of these differences for ECG interpretation used in the cardiovascular screening of athletes. Design: Observational cross-sectional study. Methods: 315 athletes were enrolled in the study (150 males and 165 females, mean age 23,7±6,6 and 20,7±6,8, respectively). All study participants underwent clinical examination and 12-lead electrocardiogram (12-lead ECG), scored according to 2017 International recommendations for electrocardiographic interpretation in athletes. Results: Males were older (23,7±6,6 years vs. 20,7 years±6,8; p<0,0001) and had more years of training (11,8±6,7 vs. 9,07±6,1; p=0,0003) than female athletes. Female athletes had significantly higher resting heart rates (67/min vs. 61/min; p<0,0001) and QTc intervals (424,5±19,4ms vs. 338,6±22,3ms; p<0,0001). Male athletes were more likely to have isolated QRS voltage criteria for left ventricular hypertrophy (Sokolow-Lyon index) (2,6±0,8mV vs. 2,05±0,5mV; p<0,0001) and QRS duration (96,1±13,1ms vs. 86,9±9,4ms; p<0,0001). Sinus bradycardia <50bpm was more commonly seen in male athletes than in female (14% vs. 5,45%; p=0,009). Sinus arrhythmia occurred more frequently in female athletes (21,8% vs. 12,6%; p=0,03). Conclusions: This study demonstrates gender-related differences in ECGs of trained athletes that should be considered in their cardiovascular screening.