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Peer-Reviewed Publication
JACC Adv2026;5(9):103153.August 20, 2026Journal Article

The Athlete's ECG: Sport-Specific Patterns, Physiological Remodeling, and Clinical Interpretation.

Filipe Ferrari1, Jason V Tso2, Grace Shadid3, Ricardo Stein4, Victor Froelicher5
1Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: ferrari.filipe88@gmail.com.
2Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.
3University of Michigan, Department of Internal Medicine, Ann Arbor, Michigan, USA.
4Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
5Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA; Cardiac Insight Inc, Bellevue, Washington, USA.
PubMed DOI

Abstract

Regular intensive training induces structural, functional, and electrical cardiac adaptations collectively known as the athlete's heart. Many electrocardiogram (ECG) findings in athletes, including sinus bradycardia, early repolarization, and increased QRS voltages, reflect benign physiological adaptation. However, some patterns overlap with features of cardiomyopathy and may pose diagnostic chall…

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