Cor Vasa 2026, 68(2):224-238 | DOI: 10.33678/cor.2025.138

(Abnormal electrocardiogram findings in athletes. A consensus statement of the European Association of Preventive Cardiology of the European Society of Cardiology. Translation prepared by the Sports Cardiology Section of the Czech Association of Preventive Cardiology of CKS)

Eliška Sovová^a, Libor Jelínek^a, Jiří Pařenica^b, Bogna Jiravská-Godula^c, Otakar Jiravský^c, Vladimír Tuka^d

^a Centrum sportovní kardiologie, Klinika tělovýchovného lékařství a kardiovaskulární rehabilitace, Lékařská fakulta Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc, Olomouc, Česká republika

^b Interní kardiologická klinika, Lékařská fakulta Masarykovy univerzity v Brně a Fakultní nemocnice Brno, Brno, Česká republika

^c Centrum sportovní kardiologie, Kardiocentrum, Nemocnice AGEL Třinec-Podlesí, Třinec, Česká republika

^d Centrum sportovní kardiologie, II. interní klinika kardiologie a angiologie, 1. lékařská fakulta Univerzity Karlovy a Všeobecná fakultní nemocnice v Praze, Praha, Česká republika

Athletes 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.

Keywords: Electrocardiogram, Sports cardiology, Sudden cardiac death

Received: December 28, 2025; Accepted: December 30, 2025; Prepublished online: June 2, 2012; Published: May 20, 2026  Show citation