A 12-lead electrocardiogram (ECG) is a screening tool to detect abnormalities that may predispose athletes to sudden cardiac death. Newer standardized criteria have been introduced to better interpret ECG data, however this research has predominantly focused on male athletes. It is important to include female athletes in research to better define ECG characteristics in this population. The purpose of this study was to compare the Seattle and International Criteria ECG abnormalities in Division Ⅱ female collegiate athletes of various ethnicities.

Fifty-six females (age 20.2 ± 1.4 years; height 1.70 ± 0.7 m; weight 69.5 ± 8.9 kg) completed a resting 12-lead ECG protocol. ECG data was classified as ‘normal’ and ‘abnormal’ according to the parameters of each criterion and abnormal conditions were noted. Chi-square analysis was used to assess statistical comparisons between criteria.

There was a significant difference in abnormal classifications as the total number of ECGs identified as abnormal using the Seattle Criteria decreased from 12 (21.4%) to 2 (3.6%) when using the International Criteria (P < 0.05). African American athletes had a higher number of abnormal ECG’s compared to White and Latina athletes using the Seattle Criteria (P = 0.03).

The International Criteria significantly reduces the total number of abnormal ECG readings in female collegiate athletes compared to the Seattle Criteria and did not overly identify African American athletes with abnormalities. Further research is necessary to expand on this study and clearly define criteria for female athletes of various ethnicities.

Two-thirds of sudden cardiac deaths are attributable to underlying cardiovascular conditions in young collegiate athletes. A 12-lead exercise stress test is a screening tool that can detect these abnormalities that may predispose collegiate athletes to sudden cardiac death, and can ensure athletes meet the physical demands of training and competition. The purpose of this study was to evaluate the electrocardiographic (ECG) characteristics of Division II collegiate athletes using the Seattle Criteria.

Fifty two athletes (males = 26; females = 26) of various ethnicities (Caucasian = 65%, Latino/Hispanic = 20%, and African American = 15%); from soccer (27%), tennis (17%), basketball (15%), softball (14%), cross country (9%), volleyball (6%), football (6%), and swimming (6%) completed cardiovascular screening with resting and exercise 12-lead ECG analysis. ECG abnormalities and anthropometrics were compared across race, gender, and sports using an ANOVA. Chi-square analysis was used to test for differences in the frequency of ECG findings across gender, race, and sports.

Although sport was not a predictor for an abnormal ECG, 73% of the athletes presented with athletes' heart configuration, which was significantly higher in males than females (P = 0.02). The highest occurrence of these adaptations was observed in 100% of Latino/Hispanic athletes, compared to 75% of African American and 64% of Caucasian athletes.

With newer and more sensitive ECG screening criteria, the prevalence of false-positive tests is declining. Future research should focus on advancing the sensitivity and specificity of ECG interpretation in more diverse athletic populations regarding race and gender. The increasing incidence of sudden cardiac death in collegiate athletes warrants future research that evaluates the impact of implementing the 12-lead ECG as a standard screening tool for collegiate athletes.