The juvenile ECG pattern in adolescent athletes and non-athletes in a national cardiac screening program (BEAT-IT)

Background: Anterior T wave inversion (TWI) is frequent in healthy adolescent individuals (juvenile ECG pattern), normalising after puberty. Its clinical implications are uncertain. Aim: This study assessed a) national prevalence of anterior TWI, b) ST segment morphology, c) proportion of individuals with a juvenile ECG pattern whose ECG normalises and d) factors predicting TWI persistence >16 years.Methods: Adolescents (mean 15y) in Malta were systematically invited to enrol in a cardiac screening program. Subjects completed a health questionnaire and an ECG at their school. Participants with TWI were labelled as TWI in V1-V2 or extended TWI (V1-V3/4). The latter were followed at 1 year with a repeat ECG. Those with persistent extended anterior TWI were offered evaluation and surveillance.Results: The prevalence of isolated anterior TWI was 5.0%, commoner in females (6.3%) independent of athletic ability. Extended TWI was commoner in female athletes (4.2%, non-athletes 2.1%). Females often had shallow TWI without overt ST segment abnormalities. Deep TWI and ST segment changes were more frequent in males. Only 0.2% of cases persisted >= 16 years of age. ST segment characteristics were not able to predict T wave normalisation. No events took place during follow up (40 +/- 9 months).Conclusion: Anterior TWI is a frequent phenomenon in adolescents, especially in females. Female athletes are also more likely to have extended anterior TWI. Only 0.2% of cases have persistent anterior TWI at 16 years of age. Chest wall anatomy may explain this phenomenon in females. It is uncommon in males, hence why surveillance is more prudent.

Automated summary

This study investigated the national prevalence of anterior T wave inversion (TWI) in adolescents, as well as the ST segment morphology and factors predicting TWI persistence after the age of 16. The results showed that TWI is common in adolescents, especially in females and female athletes. Only 0.2% of cases persist after the age of 16. The study also found that chest wall anatomy in females may explain this phenomenon.