UMEM Educational Pearls

The Unforgotten: ECG Utilization to Differentiate Athletic Heart vs. Brugada

- Highly trained athletes develop ECG changes as a physiologic consequence of increased vagal tone; The ECG manifestations of early repolarization (ER) can range from simple J–point elevation to anterior (V1 to V3) "domed" ST-segment elevation and negative T wave.

- The former raises problems of differential some forms of ER with the “ coved-type” pattern seen in Brugada Syndrome (BS).

- A recent study compared the ECG tracings of 61 athletes w/a “domed” ST-segment elevation & negative T wave and 92  age/sex-matched BS patients w/a “ coved-type” pattern to identify an ECG criteria for distinguishing benign athletic changes seen in ER from BS.

- ECG analysis focused on ST-segment elevation at J-point (STJ ) and at 80 milliseconds after J-point (ST80 ).

- Athletes had a lower maximum amplitude of STJ  (p < 0.001) & lower STJ /ST80 (p < 0.001)

- All patients (100%) with BS showed a downsloping ST-segment configuration (STJ/ST80 > 1) versus only 2 (3%) athletes (p < 0.001)

- An upsloping ST-segment configuration (STJ /ST80 < 1) showed a sensitivity of 97%, a specificity of 100%, and a diagnostic accuracy of 98.7% for the diagnosis of ER.


B: Brugada 


Zorzi A, Leoni L, et al. Differential Diagnosis Between Early Repolarization of Athlete’s Heart and Coved-Type Brugada Electrocardiogram. Am J Cardiol. 2015 Feb 15;115(4):529-32.