In a multicenter Italian registry of 12,758 athletes undergoing pre-participation screening, 1.01% had abnormal ECGs, of which 19.3% were disqualified due to at-risk cardiovascular conditions, demonstrating a relevant predictive value for identifying at-risk conditions in a real-world, predominantly non-elite population.
Key Findings
Results
The overall prevalence of selected ECG abnormalities in the athletic population was 1.01%.
The multicenter registry prospectively enrolled 12,758 elite and amateur athletes
A total of 129 abnormal ECGs were identified out of 12,758 athletes
The study population was 62% males with a median age of 22.5 years (range 14-55 years)
This prevalence was lower than that reported in previous studies
ECG patterns suggestive of Brugada syndrome and ventricular pre-excitation were observed but not included in the analysis
Results
Among athletes with abnormal ECGs, 19.3% were disqualified due to an at-risk cardiovascular condition.
25 out of 129 athletes with ECG abnormalities were disqualified
All subjects with ECG abnormalities underwent a second-line diagnostic work-up
The study enrolled both elite and amateur athletes undergoing pre-participation screening (PPS)
The population was described as predominantly non-elite
Methods
The Italian pre-participation screening protocol incorporates family and personal medical history, physical examination, and a 12-lead ECG.
ECGs were interpreted according to the International Criteria for Electrocardiographic Interpretation in Athletes
Additional selected markers were added beyond standard criteria: low QRS voltages, QRS fragmentation, and early repolarization with horizontal or descending ST segment
The Italian national protocol used was COCIS, 2017 edition
The selective ECG criteria adopted were cited as a factor in interpreting the relatively low prevalence of abnormalities
Results
The ECG abnormalities investigated showed a relevant predictive value for identifying at-risk cardiovascular conditions in a real-world athletic population.
The study was described as a multicenter registry reflecting a real-world, predominantly non-elite population
The lower prevalence of abnormalities compared to previous studies was attributed to the selective ECG criteria adopted
The finding should be 'interpreted in the light of the selective ECG criteria adopted' according to the authors
The predictive value was demonstrated across both elite and amateur athletes
What This Means
This research examined the results of routine heart screening in over 12,700 Italian athletes, both elite and recreational, who underwent pre-participation cardiovascular screening as required by Italian national protocol. The screening included a 12-lead electrocardiogram (ECG), which records the heart's electrical activity. Researchers looked for specific ECG patterns that might signal an underlying heart condition, using established international guidelines plus a few additional markers such as low voltage signals, fragmented electrical patterns, and certain types of early repolarization.
The study found that about 1 in 100 athletes (1.01%) had an abnormal ECG. Of those athletes with an abnormal ECG who then underwent additional testing, roughly 1 in 5 (19.3%) were ultimately found to have a potentially dangerous heart condition serious enough to disqualify them from competitive sport. This suggests that even though the overall rate of ECG abnormalities was relatively low compared to some earlier studies — likely because stricter criteria were used — the abnormalities that were flagged were genuinely meaningful and not false alarms.
This research suggests that structured pre-participation heart screening using ECG, when interpreted with carefully defined criteria, can effectively identify athletes who may be at risk for serious cardiac events. The findings support the value of ECG-based screening programs in real-world athletic populations that are mostly amateur rather than elite, and highlight that the specific criteria used to define an 'abnormal' ECG can significantly affect how many athletes are flagged and how meaningful those flags are.
Palamà Z, Scarà A, Robles A, De Luca G, Santilio L, Borrelli A, et al.. (2026). Prevalence and significance of ECG abnormalities in athletes: Data from a multicenter Italian registry.. International journal of cardiology. https://doi.org/10.1016/j.ijcard.2026.134581