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Cardiac screening of athletes: differences in ECG features in under-represented populations

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Cardiac screening of athletes: differences in ECG features in under-represented populations

Dr Jessica Orchard, University of Sydney

2020 Postdoctoral Fellowship

Years funded: 2021-2023

BACKGROUND: To reduce the incidence of sudden cardiac death, the Australasian College of Sport and Exercise Physicians (ACSEP) and European Society of Cardiology (ESC) recommend pre participation screening of elite athletes including 12-lead electrocardiogram (ECG). Studies indicate ethnicity and gender play a role in athlete cardiovascular adaptation.


  • Athlete ECG interpretation guidelines are based on available data predominantly from male Caucasian and African-American athletes. Other ethnicities and female athletes are under-represented, which has important implications for appropriate ECG interpretation.
  • Screening and traditional monitors cannot capture all abnormalities, especially transient exercise-induced arrhythmias. The inability to diagnose arrhythmias can lead to increased cardiovascular risk for those undertaking exercise.


  • We will collect new data from athletes of various ethnicities (eg indigenous Australians) and female athletes across multiple sports to document any differences in ECG features
  • We will trial novel smartphone ECGs (iECGs) to see if they effectively capture transient arrhythmias occurring during high-intensity exercise. An iECG can record an electrocardiogram trace from multiple leads in 30 seconds without the need for bulky or invasive monitoring equipment.


  • Increased accuracy of cardiac screening for under-represented populations by generating additional data which could lead to changes in guidelines.
  • Improved diagnosis/monitoring of transient exercise-induced arrhythmias through innovative iECG technology which is portable and affordable.

Our team is an established group of outstanding researchers. We are the only group to have designed and audited a cardiac screening program in elite Australian sport and with expertise in studying iECGs. We have direct access to numerous sports for recruitment of athletes and all the required sports cardiology, sports medicine and epidemiology expertise.

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