Table 1.

Common pitfalls of electrocardiogram interpretation in athletes using the International Criteria

ECG Abnormality	Common Pitfalls
Inferior TWI	Classified as abnormal with TWI in lead III plus aVF or lead II. Per the International Criteria, TWI in lead III is not considered abnormal; thus, abnormal inferior TWI requires TWI in both lead II and aVF (Fig. 1)
Black athlete repolarization pattern	ECGs are classified as abnormal, which have a physiologic Black athlete repolarization pattern consisting of J-point elevation with convex ST-segment elevation and TWI confined to V1–V4 (Fig. 2). Extension of TWI into V5 is an abnormal finding and not part of the Black athlete repolarization pattern
Pathologic Q waves	Classified as abnormal when the Q wave is long and thin but does not meet newer criteria including a Q/R > 0.25 or Q wave >40 ms duration (Fig. 3)
Borderline ECG findings	Athletes with 1 borderline ECG finding (eg, axis deviation, atrial enlargement, or complete RBBB) are flagged as abnormal when the International Criteria requires 2 borderline findings (Fig. 4)