# The 12‐Lead Electrocardiogram of the Rugby Football League Athlete: Impact of Sex and Age

## TL;DR

This study compares ECG readings in male and female rugby athletes of different ages, showing how sex and age influence heart electrical patterns.

## Contribution

The study provides new insights into how sex and age affect ECG parameters in rugby athletes, suggesting the need for tailored screening guidelines.

## Key findings

- Male athletes showed longer PR intervals, QRS duration, and higher voltage criteria for ventricular hypertrophy compared to females.
- Adult athletes had lower resting heart rates and reduced right ventricular hypertrophy criteria compared to pediatric athletes.
- Training hours influenced ECG differences in adult athletes, with males still showing longer PR intervals and QRS duration than females.

## Abstract

Electrocardiogram (ECG) findings in male Rugby Football League (RFL) athletes have previously been investigated but variations in other demographics are less understood. The study examined 161 ECGs in male and female, paediatric (< 18 years old) and adult (≥ 18 years old) RFL athletes. Athletes (65% male, 35% female) aged 14–33 years underwent a 12‐lead ECG that was assessed for training‐related cardiac electrical adaptations. Four athletes with abnormal ECGs were excluded. Results indicated that male athletes had an increased PR interval (152 ± 32 vs. 140 ± 19 ms; p < 0.001), QRS duration (98 ± 7 vs. 87 ± 6 ms; p < 0.001), voltage criteria for right (6 ± 3 vs. 4 ± 2 mm; p < 0.001) and left (33 ± 9 vs. 27 ± 7 mm; p < 0.001) ventricular hypertrophy (RVH/LVH) compared to females, who exhibited increased resting heart rate (HR) (67 ± 11 vs. 62 ± 11 bpm; p < 0.001) and QTc intervals (408 ± 45 vs. 398 ± 22 ms; p = 0.028). Adult athletes had a reduced HR (61 ± 10 vs. 66 ± 13 bpm; p < 0.001) and RVH criteria (5 ± 2 vs. 7 ± 3 mm; p = 0.015) compared to paediatric athletes. When controlling for weekly training hours in adult athletes, males present only a longer PR interval (156 ± 32 vs. 141 ± 19 ms; p < 0.037) and QRS duration (99 ± 7 vs. 87 ± 7 ms; p < 0.001) when compared to females. These results highlight the need for tailored cardiac screening guidelines that account for an RFL athlete's sex, age and training exposure.