International criteria for electrocardiographic interpretation in athletes: Consensus statement.

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD

Prevalence of and Predictors for QT interval Prolongation and Adverse Outcomes in an Acutely Ill Cohort: The QTIP Study.

QT interval prolongation on the electrocardiogram is a marker of abnormal ventricular repolarization and is associated with Torsades de Pointes, sudden death, and all-cause mortality in outpatient samples. This is the first inpatient study of acutely ill adults performed to determine the: 1) need for QT monitoring as outlined in American Heart Association (AHA) guidelines, 2) prevalence and predictors of QT prolongation, 3) association of QT prolongation with hospital length of stay and all-cause mortality and 4) ability of acute care nurses to perform accurate QT measurement by routine manual methods. Methods: Special study software (Philips Healthcare, Andover, MA) was installed to measure the QT and heart-rate-corrected QT (QTc) interval every minute in all patients admitted to 5 hospital units over a 2-month period. Patient data were abstracted directly from the medical record. Nurses' knowledge and skills were assessed by pre-post tests conducted during QT-related classes repeated 44 times on all nursing shifts. Nurses were taught how to measure the QT interval from a rhythm strip using hand-held calipers and to calculate the QTc using the Bazett formula. Results: Patients. 67,648 hours of QT data were obtained from 1039 patients. 73% of patients had at least 1 AHA indication for QT monitoring. 24% had an episode of dangerous QT interval prolongation > 500 milliseconds lasting 15 minutes or more. In a multivariate logistic regression analysis, predictors of QT prolongation were female sex, number of proarrhythmic drugs, low potassium or calcium, high glucose or creatinine, and history of stroke or hypothyroidism. An episode of QT prolongation was associated with longer length of stay (11.53 v 5.52 days, p <.0005) and greater all-cause mortality (8.7% v 2.6%, Fishers exact p < .0005). Patients with QT prolongation had 3 times the odds for all-cause mortality than those without (OR 2.99; 95% C.I., 1.1 - 8.1). Nurses. 391 participated in the classes (81.5% response rate). Education improved nurses' QT knowledge scores (44% v 77%, p <.0005). Nurses ability to calculate the QTc interval also improved (5.6% v 51.9%, p <.0005). Conclusion. A majority (73%) of acutely ill patients need QT monitoring and a significant proportion (24%) develop dangerous QT prolongation. QT prolongation is associated with longer hospitalization and 3 times the odds for mortality. With education, nurses' ability to perform QT measurement improves; however, an unacceptably high proportion (48%) is still unable to correctly measure the QTc interval. These data suggest that the need for QT monitoring is high and that software added to hospital cardiac monitors may be valuable to identify high risk patients who may warrant closer follow-up