Prevalence and determinants of low QRS voltages and QRS fragmentation in children and adolescents undergoing sports pre-participation screening.

AIMS: Low QRS voltages (LQRSV) in limb leads and QRS fragmentation (FQRS) are possible electrocardiographic signs of myocardial fibrosis and cardiomyopathy, but they are not listed in current criteria for interpreting athlete's electrocardiogram (ECG). We investigated the prevalence and determinants of LQRSV and FQRS in a cohort of young apparently healthy athletes undergoing pre-participation screening (PPS). METHODS AND RESULTS: We analysed a consecutive series of 2140 ECG obtained during PPS of young athletes (mean age 12.5 ± 2.6 years, 7-18-year-old, 49% males). The peak-to-peak QRS voltage was measured in all limb leads, and LQRSV were defined when maximum value was <0.5 mV. Fragmented QRS morphologies were grouped into five patterns. Lead aVR was not considered. Maximum peak-to-peak QRS voltage in limb leads was 1.4 ± 0.4 mV, similar between younger and older athletes, but significantly lower in females than males (1.35 ± 0.38 mV vs. 1.45 ± 0.42 mV; P < 0.001). There was a weak correlation between maximal QRS voltages and body mass index (BMI), but not with type of sport or training load. Only five (0.2%) individuals showed LQRSV. At least one fragmented QRS complex was identified in 831 (39%) individuals but excluding the rSr' pattern in V1-V2, only 10 (0.5%) showed FQRS in ≥2 contiguous leads. They were older than those without FQRS, but did not differ in terms of gender, BMI, type of sport, or training load. CONCLUSION: Low QRS voltages in limb leads and FQRS in ≥2 contiguous leads excluding V1-V2 are rare in young apparently healthy athletes and are not related to the type and intensity of sport activity. Therefore, they may require additional testing to rule out an underlying disease particularly when other abnormalities are present.

Low QRS voltages (LQRSV) in limb leads and QRS fragmentation (FQRS) are possible electrocardiographic signs of myocardial fibrosis and cardiomyopathy. In our study, we analysed the occurrence and characteristics of FQRS and LQRSV in young athletes undergoing pre-participation screening.We found a low prevalence of these abnormalities, with only 0.2% showing LQRSV and 0.5% displaying FQRS.These abnormalities were not associated with factors such as gender, age, type of sport, or training load.

A feedback-controlled treadmill (treadmill-on-demand) and the spontaneous speed of walking and running in humans.

A novel apparatus, composed by a controllable treadmill, a computer, and an ultrasonic range finder, is here proposed to help investigation of many aspects of spontaneous locomotion. The acceleration or deceleration of the subject, detected by the sensor and processed by the computer, is used to accelerate or decelerate the treadmill in real time. The system has been used to assess, in eight subjects, the self-selected speed of walking and running, the maximum "reasonable" speed of walking, and the minimum reasonable speed of running at different gradients (from level up to +25%). This evidenced the speed range at which humans neither walk nor run, from 7.2 +/- 0.6 to 8.4 +/- 1.1 km/h for level locomotion, slightly narrowing at steeper slopes. These data confirm previous results, obtained indirectly from stride frequency recordings. The self-selected speed of walking decreases with increasing gradient (from 5.0 +/- 0.8 km/h at 0% to 3.0 +/- 0.9 km/h at +25%) and seems to be approximately 30% higher than the speed that minimizes the metabolic energy cost of walking, obtained from the literature, at all the investigated gradients. The advantages, limitations, and potential applications of the newly proposed methodology in physiology, biomechanics, and pathology of locomotion are discussed in this paper.