ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2022
Prevalence and clinical significance of isolated low QRS voltages in young athletes.
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20 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- Cardiac evaluation of paediatric athletes.European heart journal · 2026Guideline
- Sudden Death in Young Competitive Athletes Due to Arrhythmogenic Cardiomyopathy: A 4-Decade National Referral Center Experience.Circulation. Arrhythmia and electrophysiology · 2026Article
- Abnormal electrocardiogram findings in athletes.European heart journal · 2026Review
- Beyond Racial Categorization in Sports Cardiology: A Systematic Review of Cardiac Adaptations in Athletes.Journal of clinical medicine · 2025Review
- Towards smarter screening: refining ECG criteria for the youngest athletes.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Article
- Prevalence and relation to training of electrocardiographic findings in Caucasian children and adolescents 8- to 18-year-old practicing competitive sport.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Observational
- Cardiovascular evaluation of athletes ahead of participation.Frontiers in cardiovascular medicine · 2025Article
- Cardiac Screening in Athletes: Current Status and Future Challenges.Open access journal of sports medicine · 2025Review
- Athlete's ECG Made Easy: A Practical Guide to Surviving Everyday Clinical Practice.Journal of cardiovascular development and disease · 2024Review
- The 2023 European Task Force Criteria for Diagnosis of Arrhythmogenic Cardiomyopathy: Historical Background and Review of Main Changes.Reviews in cardiovascular medicine · 2024Review
- Early detection of low QRS voltage and its association with mortality in patients with sepsis.Scientific reports · 2024Article
- Arrhythmogenic Cardiomyopathy: Current Updates and Future Challenges.Reviews in cardiovascular medicine · 2024Review
- Review
- The International Criteria for Electrocardiogram Interpretation in Athletes: Common Pitfalls and Future Directions.Cardiac electrophysiology clinics · 2024Review
- Evolving spectrum of arrhythmogenic cardiomyopathy: Implications for Sports Cardiology.Clinical cardiology · 2023Review
- The electrocardiogram in non-ischaemic-dilated cardiomyopathy.European heart journal supplements : journal of the European Society of Cardiology · 2023Article
- The value of the 12-lead electrocardiogram in the prediction of sudden cardiac death.European heart journal supplements : journal of the European Society of Cardiology · 2023Article
- The International Criteria for Electrocardiogram Interpretation in Athletes: Common Pitfalls and Future Directions.Cardiology clinics · 2023Review
- New Diagnostic Approach to Arrhythmogenic Cardiomyopathy: The Padua Criteria.Reviews in cardiovascular medicine · 2022Review
- Cardiovascular screening of athletes.Indian pacing and electrophysiology journalReview
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Authors and funding
19 authors at 7 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsLow QRS voltages (peak to peak <0.5 mV) in limb leads (LQRSV) on the athlete's electrocardiogram (ECG) may reflect an underlying cardiomyopathy, mostly arrhythmogenic cardiomyopathy (ACM) or non-ischaemic left ventricular scar (NILVS). We studied the prevalence and clinical meaning of isolated LQRSV in a large cohort of competitive athletes. METHODS AND
resultsThe index group included 2229 Italian competitive athletes [median age 18 years (16-25), 67% males, 97% Caucasian] without major ECG abnormalities at pre-participation screening. Three control groups included Black athletes (N = 1115), general population (N = 1115), and patients with ACM or NILVS (N = 58). Echocardiogram was performed in all athletes with isolated LQRSV and cardiac magnetic resonance (CMR) in those with ventricular arrhythmias or echocardiographic abnormalities. The isolated LQRSV pattern was found in 1.1% index athletes and was associated with increasing age (median age 28 vs. 18 years; P < 0.001), elite status (71% vs. 34%; P < 0.001), body surface area, and body mass index but not with sex, type of sport, and echocardiographic left ventricular mass. The prevalence of isolated LQRSV was 0.2% in Black athletes and 0.3% in young individuals from the general population. Cardiomyopathy patients had a significantly greater prevalence of isolated LQRSV (12%) than index athletes, Black athletes, and general population. Five index athletes with isolated LQSRV and exercise-induced ventricular arrhythmias underwent CMR showing biventricular ACM in 1 and idiopathic NILVS in 1.
conclusionsUnlike cardiomyopathy patients, the ECG pattern of isolated LQRSV was rarely observed in athletes. This ECG sign should prompt clinical work-up for exclusion of an underlying cardiomyopathy.
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