Sex differences and physical activity associations with electrocardiographic patterns in amateur athletes: a cross-sectional study

Introduction: The increase in sudden death cases among Moroccan amateur athletes highlights the importance of thorough medical examinations including electrocardiograms. Objective: This cross-sectional study aimed to identify the frequency of ECG findings in Moroccan amateur athletes, examine sex disparities, and assess how physical activity levels affect cardiac electrical patterns. Methodology: The study included 149 amateur athletes (70 men, 79 women) from the University Hassan 1st in Settat. Participants underwent 12-lead ECG, anthropometric measurements, and physical activity assessment using the International Physical Activity Questionnaire - Short Form. Results: Male athletes showed significantly higher rates of sinus bradycardia (41.4% vs 12.7%) and ST-segment elevation (41.4% vs 0%) than female athletes (p<.0001). High levels of physical activity were significantly associated with training-related ECG changes (p=.010) and ST-segment elevation (p=.027). Discussion: These findings emphasize the importance of considering physical activity levels when interpreting ECG patterns in amateur athletes and highlight significant sex differences in cardiac adaptations. Conclusions: Sex-specific ECG interpretation guidelines are needed for amateur athletes, with particular attention to training-related adaptations in males and the relationship between physical activity intensity and cardiac electrical patterns.