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Medicina dello Sport 2011 December;64(4):423-34


language: English, Italian

Negative T waves in right precordial leads in pre-adolescent subjects: a personal experience

Attisani G. 1, 2, Faiola F. 1, 2, Luciani U. 1, 2, Bianchi G. 1, 2, Veicstenas A. 2, 3, Casasco M. 2, 4, 5

1 PANATHLETICON, Sports Medicine, FMSI Operative Unit, Brescia, Italy 2 Department of Health, Nutrition and Sports Sciences, University of Milan, Milan, Italy 3 Specializing School Sports Medicine, University of Brescia, Brescia, Italy 4 Federazione Medico Sportiva Italiana – FMSI 5 University of Pavia, Pavia, Italy


Aim. Negative T waves in right precordial leads in young subjects is regarded as normal. T-wave inversion gradually declines parallel with age, and the persistence of negative T waves V1 throughV3 after adolescence should arouse suspicion of underlying heart disease. The aim of this study was to determine the prevalence of T-wave inversion in subjects aged from 6 to 18 years, the changes in T-wave patterns with growth and development, and the clinical relevance of T-wave inversion after adolescence.
Methods. Basal electrocardiography (ECG) tracings of 1858 subjects, subdivided by age group (6-8, 9-10, 11-13, 14-15, 16-18 years), were reviewed to evaluate changes over a 6-year follow-up period.
Results. T-wave inversion V1-V3 was observed in 132 (7.1%) subjects. The incidence of T-wave inversion in V1-V2 diminished from 32.2 to 3.3% of subjects, from 11 to 2.4% in V1-V3, and from 1.3 to 0.6% in V1-V4. Analysis of changes after 6 years showed the persistence T-wave inversion in only a modest percentage of subjects: children aged 6-8 years with T-wave inversion V1-V3 and V1-V4 (11 and 16%, respectively) at initial basal ECG were found to have the same pattern at 6-year follow-up assessment (1.7 and 0.8%, respectively). T-wave inversion in right precordial leads persisted in only a modest percentage of subjects during growth and development; in very few cases, persistence of T-wave inversion suggested an underlying heart condition (1 case of noncompactation of the ventricular myocardium).
Conclusions. The persistence of T-wave inversion in right precordial leads in young postadolescent athletes should prompt second level diagnostic examination and annual monitoring. The criteria should be based on anthropometric measurements and not on chronological age alone.

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