Cardiovascular screening in children and adolescents has become a prominent concern, especially as more young individuals engage in competitive sports and face the rare but devastating risk of sudden cardiac death (SCD). Pre-participation cardiovascular assessments, typically combining a comprehensive history and physical examination are intended to detect underlying cardiac conditions that predispose seemingly healthy youth to adverse events during exertion. [1]

Electrocardiography (ECG), which is the process of recording electrical activity of the heart, is a widely used clinical tool for assessing cardiovascular and cardiopulmonary function. In a standard 12‑lead ECG, electrodes are strategically placed on the patient's chest and limbs to detect even the slightest changes in the heart's electrical signals, providing valuable insights into cardiac health. [2]

Most existing ECG interpretation criteria have been developed based on adult populations or elite athletes, with relatively limited normative data drawn from healthy, general pediatric populations. In children and adolescents interpreting ECGs can be particularly challenging. Age-related physiological changes in the cardiovascular system during growth and puberty can produce ECG patterns that, while normal, may mimic pathological conditions. This creates a gap in the ability of clinicians to differentiate between benign findings and early markers of cardiac disease in school-aged children. [3,4]

Accurate ECG interpretation in athletes necessitates specialized training and a meticulous approach to differentiate between physiological adaptations of the athletic heart and abnormal findings suggestive of underlying cardiac pathology. Athletic training can induce a range of ECG changes—such as sinus bradycardia, early repolarization, or increased QRS voltages—that are typically benign. However, without appropriate expertise, these normal variants may be misclassified as medical abnormalities, leading to unnecessary investigations or restrictions from sport. To address this challenge, international consensus statements—such as the 2017 International Criteria for ECG Interpretation in Athletes and the 2020 ESC guidelines—provide standardized frameworks for distinguishing normal ECG variants from abnormal patterns that warrant further evaluation. [5]

By identifying age- and sex-specific variations in ECG parameters within this population, the study aims to support safer sports participation through a more accurate interpretation of pediatric ECGs in the context of pre-participation cardiovascular screening thus reducing false-positive findings and unnecessary referrals by characterizing normal variants commonly seen in healthy young athletes.