Introduction: The use of electrocardiogram in athletes as a routine screening method for diagnosing potentially dangerous cardiovascular diseases is still an issue of debate. According to the guidelines of the European Society of Cardiology, the recording of electrocardiogram is necessary in all athletes as a screening method, whereas the guidelines of the American Heart Association do not necessitate an electrocardiogram as a screening method and they insist on detailed personal and family history and clinical examination. CLASSIFICATION OF ELECTROCARDIOGRAM CHANGES IN ATHLETES: According to the classification of the European Society of Cardiology, electrocardiogram changes in athletes are divided into two groups: a) usual (physiological) that are connected with training; b) unusual (potentially clinically relevant) that are not connected with training. SUDDEN CARDIAC DEATH IN ATHLETES: The most frequent causes include hypertrophic cardiomyopathy and congenital coronary artery anomalies, while others may be found only sporadically at autopsy. Physiological electrocardiogram changes are frequent in asymptomatic athletes and they do not require further assessment. They include sinus bradycardia, atrioventricular blocks of I and II degree--Wenkebach, isolated increased QRS voltage, incomplete right bundle branch block and early repolarization. Potentially pathological electrocardiogram changes in athletes are not frequent but they are alarming and they urge further assessment to diagnose the underlying cardiovascular disease as well as the prevention of sudden cardiac death. They include: T wave inversion, ST segment depression, complete right or left bundle branch block, atrial pre-excitation syndrome-WPW, long QT interval, short QT interval, Brugada like electrocardiogram finding.
Conclusion: Introduction of electrocardiogram recording into the screening protocol in athletes increases the sensitivity of evaluation and may help to discover asymptomatic cardiovascular diseases that may cause sudden cardiac death. Special attention and further assessment are required when the above potentially pathological electrocardiogram changes are found in athletes.