PREVALENCE OF T-WAVE INVERSION IN FEMALE ATHLETES COMPARED TO MALES

https://youtu.be/8O1PWHlLtH4 BACKGROUND: Electrocardiogram (ECG) screening is widely used in sports medicine to identify athletes at risk of sudden cardiac arrest or death (SCA/D). Abnormal ECGs are reported more frequently in females over the age of 16, often driven by T-wave inversion (TWI) in leads V1–V3, even though this finding has not been associated with adverse outcomes. PURPOSE: To evaluate sex-specific differences in ECG findings among high school athletes, with particular focus on the prevalence and distribution of TWI in leads V1–V3. METHODS: A total of 1,352 athletes underwent ECG screening (mean age 15.1 ± 1.3 years; mean heart rate 72.9 ± 13.7 bpm). Of the 1,341 athletes with reported sex, 868 were male (64.7%) and 473 female (35.3%). ECGs were analyzed for abnormal findings, including TWI, right bundle branch block (RBBB), and QTc interval. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to compare findings between sexes. RESULTS: Abnormal ECGs were uncommon (2%, 23/1,351). TWI occurred in 0.7% of athletes (9/1,340), including 0.4% of females (2/473) and 0.8% of males (7/867). All female TWI cases (100%) were isolated to leads V1–V3, compared with only a portion of male cases, in whom TWI appeared in more variable lead distributions. Females therefore showed a higher relative incidence of isolated V1–V3 TWI compared with males (OR 2.15, 95% CI 1.01–4.58). Importantly, no female athlete with isolated TWI in V1–V3 was diagnosed with a condition associated with SCA/D. RBBB was identified in 1.6% of athletes (22/1,341), with no significant sex differences (female 1.5% vs. male 1.7%, OR 0.86, 95% CI 0.34–2.15). Females also exhibited longer QTc intervals than males by 17 ms (95% CI 9–26). CONCLUSION: In this large cohort of high school athletes, abnormal ECGs were uncommon. Females demonstrated a higher incidence of isolated TWI in V1–V3, while males displayed TWI across more variable patterns. Additionally, females had longer QTc intervals, consistent with established sex-specific repolarization differences. As isolated V1–V3 TWI in females was not associated with underlying disease or increased SCA/D risk, these findings support interpreting this pattern as a benign, sex-specific variant in female athlete ECGs.