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Variability in interpretation of the electrocardiogram in young athletes: an unrecognized obstacle for electrocardiogram-based screening protocols

(2015) EUROPACE. 17(9). p.1435-1440
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Abstract
To assess in young athletes (i) the variability in the percentage of abnormal electrocardiograms (ECGs) using different criteria and (ii) the variability in ECG interpretation among cardiologists and sport physicians. Electrocardiograms of 138 athletes were categorized by seven cardiologists according to the original European Society of Cardiology (ESC) criteria by Corrado (C), subsequently modified by Uberoi (U), Marek (M), and the Seattle criteria (S); seven sports physicians only used S criteria. The percentage of abnormal ECGs for each physician was calculated and the percentage of complete agreement was assessed. For cardiologists, the median percentage of abnormal ECGs was 14% [interquartile range (IQR) 12.5-20%] for C, 11% (IQR 9.5-12.5%) for U [not significant (NS) compared with C], 11% (IQR 10-13%) for M (NS compared with C), and 7% (IQR 5-8%) for S (P < 0.005 compared with C); complete agreement in interpretation was 64.5% for C, 76% for U (P < 0.05 compared with C), 74% for M (NS compared with C), and 84% for S (P < 0.0005 compared with C). Sport physicians classified a median of 7% (IQR 7-11%) of ECGs as abnormal by S (P = NS compared with cardiologists using S); complete agreement was 72% (P < 0.05 compared with cardiologists using S). Seattle criteria reduced the number of abnormal ECGs in athletes and increased agreement in classification. However, variability in ECG interpretation by cardiologists and sport physicians remains high and is a limitation for ECG-based screening programs.
Keywords
Screening, ECG, Athletes, CRITERIA, ACCURACY, DEATH

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MLA
Berte, Benjamin, Mattias Duytschaever, Juliana Elices, et al. “Variability in Interpretation of the Electrocardiogram in Young Athletes: An Unrecognized Obstacle for Electrocardiogram-based Screening Protocols.” EUROPACE 17.9 (2015): 1435–1440. Print.
APA
Berte, B., Duytschaever, M., Elices, J., Kataria, V., Timmers, L., Van Heuverswyn, F., Stroobandt, R., et al. (2015). Variability in interpretation of the electrocardiogram in young athletes: an unrecognized obstacle for electrocardiogram-based screening protocols. EUROPACE, 17(9), 1435–1440.
Chicago author-date
Berte, Benjamin, Mattias Duytschaever, Juliana Elices, Vikas Kataria, Liesbeth Timmers, Frederic Van Heuverswyn, Roland Stroobandt, et al. 2015. “Variability in Interpretation of the Electrocardiogram in Young Athletes: An Unrecognized Obstacle for Electrocardiogram-based Screening Protocols.” Europace 17 (9): 1435–1440.
Chicago author-date (all authors)
Berte, Benjamin, Mattias Duytschaever, Juliana Elices, Vikas Kataria, Liesbeth Timmers, Frederic Van Heuverswyn, Roland Stroobandt, Jan De Neve, Karel Watteyne, Elke Vandensteen, Yves Vandekerckhove, and Rene Tavernier. 2015. “Variability in Interpretation of the Electrocardiogram in Young Athletes: An Unrecognized Obstacle for Electrocardiogram-based Screening Protocols.” Europace 17 (9): 1435–1440.
Vancouver
1.
Berte B, Duytschaever M, Elices J, Kataria V, Timmers L, Van Heuverswyn F, et al. Variability in interpretation of the electrocardiogram in young athletes: an unrecognized obstacle for electrocardiogram-based screening protocols. EUROPACE. 2015;17(9):1435–40.
IEEE
[1]
B. Berte et al., “Variability in interpretation of the electrocardiogram in young athletes: an unrecognized obstacle for electrocardiogram-based screening protocols,” EUROPACE, vol. 17, no. 9, pp. 1435–1440, 2015.
@article{5846350,
  abstract     = {To assess in young athletes (i) the variability in the percentage of abnormal electrocardiograms (ECGs) using different criteria and (ii) the variability in ECG interpretation among cardiologists and sport physicians. 
Electrocardiograms of 138 athletes were categorized by seven cardiologists according to the original European Society of Cardiology (ESC) criteria by Corrado (C), subsequently modified by Uberoi (U), Marek (M), and the Seattle criteria (S); seven sports physicians only used S criteria. The percentage of abnormal ECGs for each physician was calculated and the percentage of complete agreement was assessed. For cardiologists, the median percentage of abnormal ECGs was 14% [interquartile range (IQR) 12.5-20%] for C, 11% (IQR 9.5-12.5%) for U [not significant (NS) compared with C], 11% (IQR 10-13%) for M (NS compared with C), and 7% (IQR 5-8%) for S (P < 0.005 compared with C); complete agreement in interpretation was 64.5% for C, 76% for U (P < 0.05 compared with C), 74% for M (NS compared with C), and 84% for S (P < 0.0005 compared with C). Sport physicians classified a median of 7% (IQR 7-11%) of ECGs as abnormal by S (P = NS compared with cardiologists using S); complete agreement was 72% (P < 0.05 compared with cardiologists using S). 
Seattle criteria reduced the number of abnormal ECGs in athletes and increased agreement in classification. However, variability in ECG interpretation by cardiologists and sport physicians remains high and is a limitation for ECG-based screening programs.},
  author       = {Berte, Benjamin and Duytschaever, Mattias and Elices, Juliana and Kataria, Vikas and Timmers, Liesbeth and Van Heuverswyn, Frederic and Stroobandt, Roland and De Neve, Jan and Watteyne, Karel and Vandensteen, Elke and Vandekerckhove, Yves and Tavernier, Rene},
  issn         = {1099-5129},
  journal      = {EUROPACE},
  keywords     = {Screening,ECG,Athletes,CRITERIA,ACCURACY,DEATH},
  language     = {eng},
  number       = {9},
  pages        = {1435--1440},
  title        = {Variability in interpretation of the electrocardiogram in young athletes: an unrecognized obstacle for electrocardiogram-based screening protocols},
  url          = {http://dx.doi.org/10.1093/europace/euu385},
  volume       = {17},
  year         = {2015},
}

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