Long-term follow-up of early repolarization pattern in elite athletes

BACKGROUND: Early repolarization pattern (ERP) is considered a benign variant of the electrocardiogram (ECG), more frequent in athletes. However, prospective studies suggested that ERP is associated with an increased risk of sudden cardiac death (SCD). The purpose of this study is to determine the prevalence, clinical characteristics, and long-term outcome of ERP in elite athletes during professional activity and after retirement. METHODS AND RESULTS: A cohort of 299 white elite athletes recruited between 1960 and 1999 was retrospectively analyzed. Athletes were eligible if they had participated for at least 6 consecutive months in high competition and retired for a minimum of 5 years before inclusion. Clinical data and ECG were abstracted from the clinical records using a questionnaire, and outcomes after a mean follow-up of 24 years were registered. Among the 299 athletes, 66% were men with a mean age of 20 (SD 6.4) years. ERP was found in 31.4% of participants, and it was located in lateral ECG leads in 57.4% of cases, in inferior leads in 6.4%, and in both leads in the remaining 36.2%. After retirement, ERP still persisted in 53.4% of athletes. Predictive factors for the persistence were: left ventricular hypertrophy signs at the baseline ECG (odds ratio [OR] 4.35; 95% confidence interval [CI], 1.43-13.24; P =.010), sinus bradycardia after retirement (OR 2.56; 95% CI, 1.09-5.99; P =.031), and presence of ERP during the sportive career (OR 20.35; 95% CI, 8.54-48.51; P <.001). After a mean follow-up of 24 years, no episodes of SCD occurred. CONCLUSIONS: A third of elite athletes presented ERP, and this persisted in 53.4% of cases after retirement. After a long follow-up period, no difference in outcome of SCD was seen.