Electrocardiograma en el atleta pediátrico: adaptaciones fisiológicas, hallazgos borderline y criterios de alarma

Alan García Yánez; Miguel Mateo Montañez Soler; Kevin Villa Lopera; Hernando Baquero Aguilera

doi:10.47487/apcyccv.v7i2.626

Authors

Alan García Yánez Shizo Sports Medicine, División de Medicina del Deporte y Actividad Física, Bogotá, Colombia. https://orcid.org/0000-0002-1560-5403
Miguel Mateo Montañez Soler Fortaleza Fútbol Club, División de Medicina del Deporte y Actividad Física, Bogotá, Colombia. https://orcid.org/0009-0007-4056-4977
Kevin Villa Lopera Independiente Yumbo Fútbol Club, División de Medicina del Deporte y Actividad Física, Yumbo, Colombia. https://orcid.org/0009-0000-1704-6775
Hernando Baquero Aguilera Shizo Sports Medicine, División de Medicina del Deporte y Actividad Física, Bogotá, Colombia. https://orcid.org/0009-0004-4207-3424

DOI:

https://doi.org/10.47487/apcyccv.v7i2.626

Keywords:

Electrocardiography, Pediatrics, Exercise, Death, Sudden, Cardiac, Risk Assessment

Abstract

Electrocardiographic (ECG) interpretation in the pediatric athlete is clinically challenging due to the interaction between cardiovascular growth, electrophysiological maturation, and exercise-induced adaptations. Unlike adults, the electrical phenotype in children and adolescents reflects a dynamic developmental process, leading to greater variability in ECG patterns. Accurate differentiation between development-related findings, physiological adaptations to training, and alterations suggestive of structural or electrical heart disease is essential to optimize early detection of clinically relevant cardiovascular conditions while avoiding unnecessary restrictions on sports participation. This review summarizes the electrophysiological basis of ECG findings in young athletes and proposes a clinically oriented classification of findings into physiological, borderline, and abnormal categories, integrating contemporary interpretation criteria. A practical approach to ECG interpretation and the rational use of complementary diagnostic testing is also presented, aiming to improve diagnostic accuracy and support safe sports participation in pediatric populations.

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References

Idiazabal-Ayesa U, Ramírez-Vélez R, Sanz-de la Garza M, Izquierdo M. Electrocardiographic findings in pediatric versus young-adolescent athletes: A comparative analysis using general international criteria. Int J Cardiol. 2023;390:131201. doi: 10.1016/j.ijcard.2023.131201.

Miliaraki M, Germanakis I. Pediatric Electrocardiogram in Preparticipation Screening: Narrative Review of Normal Values in Key Features. Children (Basel). 2026;13(2):209. doi: 10.3390/ children13020209.

Ragazzoni GL, Cavigli L, Cavarretta E, Maffei S, Mandoli GE, Pastore MC, Valente S, Focardi M, Cameli M, Di Salvo G, Pieles G. How to evaluate resting ECG and imaging in children practising sport: a critical review and proposal of an algorithm for ECG interpretation. Eur J Prev Cardiol. 2023;30(5):375-383. doi: 10.1093/eurjpc/zwac218.

Miljoen H, Bruyndonckx L. Paediatric athletes are not just little athletes: setting up criteria for electrocardiogram and cardiac ultrasound evaluation of children practising sport. Eur J Prev Cardiol. 2023;30(5):373-4. doi: 10.1093/eurjpc/zwac221.

Małek ŁA, Dotka M, Brzezińska K, Pyndryk P, Materkowski M, Wiecha S. Electrocardiographic Changes in Juvenile Athletes in Relation to Sex, Age, and Sport Category. Pediatr Cardiol. 2026;47(4):1629-1638. doi: 10.1007/s00246-025-03945-y.

Dean PN, Brothers JA, Burns K, Edelson JB, Etheridge S, Phelan DM, et al. The cardiovascular care of the pediatric athlete. J Am Coll Cardiol. 2025;85(13):1434-1454. doi: 10.1016/j.jacc.2025.02.010.

Palermi S, Cavarretta E, D’Ascenzi F, Castelletti S, Ricci F, Vecchiato M, et al. Athlete’s Heart: A cardiovascular step-by-step multimodality approach. Rev Cardiovasc Med. 2023;24(5):151. doi: 10.31083/j. rcm2405151.

D’Ascenzi F, Ragazzoni GL, Boncompagni A, Cavigli L. Sports cardiology: A glorious past, a well‐defined present, a bright future. Clin Cardiol. 2023;46(9):1015-1020. doi: 10.1002/clc.24112.

Orchard J, Harmon KG, D’Ascenzi F, Meyer T, Pieles GE. What is the most appropriate age for the first cardiac screening of athletes?. J Sci Med Sport. 2024;27(9):583-593. doi: 10.1016/j.jsams.2024.05.017.

Vecchiato M, Quinto G, Borasio N, Palermi S, Berton G, Battista F, et al. The fragmented QRS complex in lead V1: time for an update of the athlete’s ECG?. J Cardiovasc Transl Res. 2024;17(1):24-32. doi: 10.1007/s12265-023-10448-9.

Doumparatzi M, Sotiriou P, Deligiannis A, Kouidi E. Electrocardiographic characteristics of pediatric and adolescent football players. Sports Med Health Sci. 2023;6(2):179-184. doi: 10.1016/j.smhs.2023.12.004.

Warrington C, Thompson A, Read J, Abram J, Mill N, Cooper R, et al. The 12‐Lead Electrocardiogram of the Rugby Football League Athlete: Impact of Sex and Age. Eur J Sport Sci. 2025;25(5):e12304. doi: 10.1002/ejsc.12304.

Shakya B. Insight into ECG: the crucial contribution of ECG technicians in cardiological monitoring and diagnosis. Int J Res Med Sci. 2025;13(7):3117. doi: 10.18203/2320-6012.ijrms20252058.

Díaz-González L, de la Guía-Galipienso F, Carro A, Sanz-de la Garza M, Madaria Z, Serratosa L, et al. Cribado cardiológico preparticipativo en deportistas recreativos, competitivos y de alto nivel en diferentes grupos de edad. Rev Esp Cardiol. 2024;59(3):153-260. doi: 10.1016/j. rccl.2024.03.00.

Idiazabal-Ayesa U, de la Guía-Galipienso F, Sanz-de la Garza M, Ramírez-Vélez R, Martínez-Olorón P, Reyero-Díez D, et al. Influences of Age, Sex, and Heart Rate on Corrected QT Interval Values Calculated by Using Bazett and Fridericia Formulas in Children and Young Adolescent Athletes. Clin J Sport Med. 2025. doi: 10.1097/ JSM.0000000000001374.

Colombo JN, Sawda CN, White SC. Cardiac concerns in the pediatric athlete. Clin Sports Med. 2022;41(3):529-548. doi: 10.1016/j. csm.2022.02.010.

Dilek SÖ, Erdem S, Özbarlas N. Evaluation of cardiac biomarkers, electrocardiogram changes and echocardiography findings before and after exercise in paediatric athletes. Cukurova Med J. 2023;48(3):929-38. doi: 10.17826/cumj.1325501.

Albiński M, Saubade M, Menafoglio A, Meyer P, Capelli B, Perrin T, et al. Diagnostic yield and cost analysis of electrocardiographic screening in Swiss paediatric athletes. J Sci Med Sport. 2022;25(4):281-286. doi: 10.1016/j.jsams.2021.11.039.

Ebadi AA. Student athlete ECGs: Case examples of normal and abnormal sport physical ECGs and when you should refer your patient for cardiology evaluation. Prog Pediat. Cardiol. 2022;65:101519. doi: 10.1016/j.ppedcard.2022.101519.

Goff NK, Hutchinson A, Koek W, Kamat D. Meta-analysis on the effectiveness of ECG screening for conditions related to sudden cardiac death in young athletes. Clin Pediatr (Phila). 2023;62(10):1158- 1168. doi: 10.1177/00099228231152857.

Pentikäinen H, Toivo K, Kokko S, Alanko L, Heinonen OJ, Nylander T, et al. Resting electrocardiogram and blood pressure in young athletes and nonathletes: A 4‐year follow‐up. Clin Physiol Funct Imaging. 2022;42(3):200-207. doi: 10.1111/cpf.12747.

Graziano F, Manfrin L, Genta EO, Balla D, Vago H, Zorzi A, et al. Interpretation of athlete’s ECG in a pediatric population using the International Criteria. Eur J Prev Cardiol. 2024;31(Supplement_1):zwae175-271. doi: 10.1093/eurjpc/zwae175.271.

Mansour NM, Abdelnaby AR, Khalil NI. Normal electrocardiographic patterns in school-aged children: Data from a sports cardiology screening program. J Electrocardiol. 2025:154142. doi: 10.1016/j. jelectrocard.2025.154142.

Vecchiato M, Baioccato V, Adami PE, Quinto G, Foccardi G, Slanzi G, et al. Early repolarization in adolescent athletes: a gender comparison of ECG and echocardiographic characteristics. Scand J Med Sci Sports. 2022;32(11):1581-1591. doi: 10.1111/sms.14232.

Schlondrop JL, Von Bergen NH, Zhang X, Hokanson JS. Survey of Pediatric Cardiologists on Screening for Conditions Associated with Sudden Cardiac Death. Pediatr Cardiol. 2026;47(5):2002-2006. doi: 10.1007/s00246-025-03987-2.

Chen SC, Tsai CF. Sex-and maturation-specific challenges in paediatric athlete electrocardiographic interpretation: beyond current criteria. Europace. 2025;27(10):euaf237. doi: 10.1093/europace/euaf237.

Schefft M, Wolf ER, Quinonez R, Haskell H, James J. Appropriate use of electrocardiography in preparticipation physical evaluations. Am Fam Physician. 2022;105(3):302-6.

Zimatore G, Gallotta MC, Campanella M, Hatzopoulos S, Skarzynski PH, Ricci M, et al. Towards a Multidisciplinary Approach of ECG Screening in Children and Adolescents: A Scoping Review (2005–2025). Children (Basel). 2025;12(11):1468. doi: 10.3390/ children12111468.

Finocchiaro G, Zorzi A, Abela M, Baggish A, Castelletti S, Cavarretta E, et al. Abnormal electrocardiogram findings in athletes: A consensus statement of the European Association of Preventive Cardiology of the European Society of Cardiology. Eur Heart J. 2026;47(2):152-169. doi: 10.1093/eurheartj/ehaf646.

Graziano F, Zorzi A, Corrado D. ECG interpretation for preparticipation screening in athletes. J Electrocardiol. 2026;94:154157. doi: 10.1016/j.jelectrocard.2025.154157.

Siebert DM, Harmon KG. Looking Under the Hood: Screening for Cardiac Abnormalities in Young Athletes. Curr Rev Musculoskelet Med. 2025;19(1):2. doi: 10.1007/s12178-025-09995-2.

Rochelson E, Howard TS, Kim JJ. Demystifying the Pediatric Electrocardiogram: Tools for the Practicing Pediatrician. Pediatr Rev. 2023;44(1):3-13. doi: 10.1542/pir.2021-005346.

Shervashidze M. Cardiovascular Screening in Pediatric Athletes: Prevalence, Risk Stratification, and Public Health Implications from a Georgian Population Cohort. Georgian Med. J. 2026;1(1):115-35. doi: 10.5281/zenodo.19091480.

Sarto P, Zorzi A, Merlo L, Vessella T, Pegoraro C, Giorgiano F, et al. Value of screening for the risk of sudden cardiac death in young competitive athletes. European heart journal. 2023;44(12):1084-92. doi: 10.1093/eurheartj/ehad017.

Lima LC, Lee L, Mahmoudian A, Adlof L, Lee Y. ECG Characteristics of Young High School Athletes in Northwest Florida. J Clin Exerc Physiol. 2024;13(2):44-51. doi: 10.31189/2165-6193-13.2.44.

Ramesh P, Dhutia H. Cardiac screening in athletes: benefits and potential challenges. Br J Cardiol. 2025;32:130-4. doi: 10.5837/ bjc.2025.048.

Ungaro S, Graziano F, Bondarev S, Pizzolato M, Corrado D, Zorzi A. Electrocardiographic clues for early diagnosis of ventricular preexcitation and non-invasive risk stratification in athletes: a practical guide for sports cardiologists. J Cardiovasc Dev Dis. 2024;11(10):324. doi: 10.3390/jcdd11100324.

Katyal A, Li CO, Franciosi S, Sanatani S. The safety of sports in children with inherited arrhythmia substrates. Front Pediatr. 2023;11:1151286. doi: 10.3389/fped.2023.1151286.

McLendon LA, Mulekar MS, Batten LA. Preparticipation electrocardiogram screening in a Gulf Coast community: a prospective study. Heart Rhythm O2. 2025;6(11):1761-1766. doi: 10.1016/j.hroo.2025.07.104.

Marshall M, Malik A, Shah M, Fish FA, Etheridge SP, Aziz PF, et al. Patterns of electrocardiographic abnormalities in children with hypertrophic cardiomyopathy. Pediatr Cardiol. 2024;45(8):1692-1701. doi: 10.1007/s00246-023-03252-4.

Lander BS, Duffy EY, Hennessey JA, Tolani S, Patel N, Bohnen MS, et al. Electrocardiographic findings in female professional basketball athletes. JAMA Cardiol. 2024;9(5):475-479. doi: 10.1001/ jamacardio.2024.0207.