Sains Malaysiana 50(11)(2021): 3355-3363

http://doi.org/10.17576/jsm-2021-5011-19

Electrocardiographic (ECG) Characteristics among Malaysia Athletes

(Pencirian Elektrokardiografi (ECG) dalam Kalangan Atlet Malaysia)

MOHAMAD SHARIFF A HAMID^1,2*, SAZLINA SHARIFF GHAZALI^3,4, AHMAD MUNAWWAR HELMI SALIM², KAMARUL HASHIMY HUSSEIN², ZULKARNAIN JAAFAR¹ & SAMIHAH ABDUL KARIM¹

¹Sports Medicine Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Federal Territory, Malaysia

²National Sports Institute of Malaysia, Bukit Jalil, 57000 Kuala Lumpur, Federal Territory, Malaysia

³Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor Darul Ehsan, Malaysia

⁴Malaysian Research Institute on Ageing, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor Darul Ehsan, Malaysia

Diserahkan: 20 Januari 2020/Diterima: 7 Mac 2021

ABSTRACT

The electrocardiogram (ECG) is a graphic representation of the heart's electrical activity. Although it has some limitations as a diagnostic or prognostic tool, it contains a wealth of information necessary for the proper care of a patient with a potential cardiovascular disease. Understanding the ECG changes among athletes would allow medical practitioners to distinguish between normal physiological adaptations and abnormal changes. However, there is limited data on the ECG characteristics among multi-ethnic athletes such as in Malaysia. This study aimed to determine the ECG characteristics and its associated factors among Malaysian national athletes. Malaysian national athletes annual pre-participation medical records were retrieved. Information on sociodemographic, sports and medical history including the 12-lead resting ECG tracings were extracted. ECG were assessed and categorised into normal, physiological adaptation changes, and abnormal ECG using the standardised ‘Seattle criteria’. Differences in ECG characteristics between genders, ethnic background, and type of sports was investigated. Additionally, factors associated with the ECG characteristics were assessed using multiple logistic regression. Majority of Malaysian national athletes had physiological adaptation ECG changes (61%). The most frequent changes were early repolarization, sinus bradycardia and isolated left ventricular hypertrophy. We found significantly higher prevalence of physiological adaptation changes among men (÷²(2,371) = 18.9; p = 0.001) and athletes of Chinese ethnicity (both genders) (÷²(2,356) = 13.8; p = 0.002). Factors associated with physiological ECG changes were men (OR=2.67; 95% CI= 1.68, 4.27; p<0.001) and Chinese ethnicity (OR=2.92; 95% CI=1.68, 4.27; p=0.039). Most athletes had physiological adaptation ECG changes which were significantly associated with male gender and Chinese ethnicity. This information would facilitate the development of a specific guideline in interpreting ECG among Malaysian athletes.

Keywords: Athletes’ heart; electrocardiogram; patterns; physiological adaptation

ABSTRAK

Elektrokardiogram (ECG) adalah gambaran grafik aktiviti elektrik jantung. Walaupun ia mempunyai beberapa batasan sebagai alat diagnostik ataupun prognostik, ia mengandungi pelbagai maklumat yang diperlukan dalam penjagaan pesakit yang berpotensi mengidap penyakit kardiovaskular. Memahami perubahan elektrokardiografi (ECG) dalam kalangan atlet akan membolehkan para pengamal perubatan membezakan antara perubahan akibat penyesuaian fisiologi normal dan perubahan yang tidak normal. Walau bagaimanapun, terdapat data terhad mengenai ciri-ciri ECG dalam kalangan atlet berbilang kaum seperti di Malaysia. Kajian ini bertujuan untuk menentukan ciri-ciri ECG dan faktor yang berkaitan dalam kalangan atlet kebangsaan Malaysia. Rekod perubatan pemeriksaan saringan kesihatan tahunan atlet kebangsaan Malaysia diperoleh untuk penilaian. Maklumat berkaitan sosiodemografi, sukan dan sejarah perubatan termasuk rekod ECG (sewaktu rehat) diekstrak. ECG dinilai dan dikategorikan kepada perubahan adaptasi fisiologi yang normal dan tidak normal ECG menggunakan 'Kriteria Seattle' yang diseragamkan. Perbezaan ciri ECG antara jantina, latar belakang etnik dan jenis sukan diselidiki. Di samping itu, faktor yang dikaitkan dengan ciri-ciri ECG dinilai dengan menggunakan regresi logistik berganda. Majoriti (61%) atlet kebangsaan Malaysia mempunyai perubahan penyesuaian fisiologi ECG terhadap sukan. Perubahan paling kerap ialah pengutuban semula awal, bradikardia sinus dan hipertrofi ventrikel kiri. Perubahan ketara perubahan penyesuaian fisiologi didapati dalam kalangan atlet lelaki (÷²(2,371) = 18.9; p = 0.001) dan atlet etnik Cina (lelaki dan wanita) (÷²(2,356) = 13.8; p = 0.002). Faktor yang dikaitkan dengan perubahan fizikal fisiologi ialah lelaki (OR = 2.67, 95% CI = 1.68, 4.27; p <0.001) dan etnik Cina (OR = 2.92; 95% CI = 1.68, 4.27; p = 0.039). Kebanyakan atlet mempunyai perubahan penyesuaian fisiologi perubahan ECG yang dikaitkan dengan jantina lelaki dan etnik Cina. Maklumat ini akan memudahkan perkembangan garis panduan khusus dalam menafsirkan ECG dalam kalangan atlet Malaysia.

Kata kunci: Corak; elektrokardiogram; jantung atlet; penyesuaian fisiologi

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*Pengarang untuk surat-menyurat; email: ayip@um.edu.my