Electrocardiographic Features Differentiating Arrhythmogenic Right Ventricular Cardiomyopathy From an Athlete's Heart

Maria J. Brosnan, Anneline S.J.M. te Riele, Laurens P. Bosman, Edgar T. Hoorntje, Maarten P. van den Berg, Richard N.W. Hauer, Michael D. Flannery, Jon M. Kalman, David L. Prior, Crystal Tichnell, Harikrishna Tandri, Brittney Murray, Hugh Calkins, Andre La Gerche*, Cynthia A. James

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)


Objectives: This study sought to compare electrocardiogram (ECG) variants in athletic and arrhythmogenic right ventricular cardiomyopathy (ARVC) cohorts matched for the confounders of age, sex, and ethnicity. Background: Anterior T-wave inversion (TWIV1−V4) is a common electrocardiographic finding in both athletes and patients with ARVC, and is a frequent conundrum in the setting of pre-participation screening. J-point elevation (JPE) has been proposed as an accurate means of identifying athletes, whereas disease markers, including premature ventricular contractions (PVCs) and low-voltage signals, have been associated with ARVC. Methods: This study examined 200 subjects with TWI V1−V4, including 100 healthy athletes and 100 ARVC patients matched 1:1 for age, sex, and ethnicity (age: 21 ± 5 years for athletes vs. 22 ± 5 years for ARVC patients; 47% male; 97% Caucasian). The presence of TWI, JPE, PVCs, and left ventricular hypertrophy (LVH) were assessed. Results: JPE was observed in 27% of athletes versus 16% of ARVC patients (p = 0.09). Thus, JPE had poor specificity (27%) and accuracy (60%) in identifying healthy athletes. In contrast, ARVC patients demonstrated a greater prevalence of precordial TWI beyond lead V3 (34% vs. 8%; p < 0.001), inferior TWI (31% vs. 3%; p < 0.001), PVCs (18% vs. 0%; p < 0.001), and lower LVH scores (SV1 + RV5; 19 ± 1 mm vs. 30 ± 1 mm; p < 0.001). These combined factors provided more reliable differentiation between health and disease (specificity 82%, accuracy 81%). Conclusions: PVCs and low QRS voltages are more prevalent among ARVC patients than athletes, whereas JPE is a relatively poor discriminator of health and disease when the confounders of age, sex, and ethnicity are considered.

Original languageEnglish
Pages (from-to)1613-1625
Number of pages13
JournalJACC: Clinical Electrophysiology
Issue number12
Publication statusPublished - 1 Dec 2018


  • arrhythmogenic right ventricular cardiomyopathy
  • athlete
  • ECG
  • pre-participation screening
  • T-wave inversion


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