Arrhythmias & electrophysiology
Sex differences in electrocardiograms of trained athletes: a systematic review and meta-analysis
Authors' conclusion
Compared with male athletes, female athletes were twice as likely to have abnormal TWI and six times as likely to have isolated TWIV1-V3, a finding which was not accompanied by diagnoses of cardiac pathology in female athletes.
Study context
- Population
- Athletes aged 16–40 years with a 12-lead screening ECG, analysis stratified by sex85 cross-sectional studies
- Participants
- 19,069 vs 57,745
- Comparison
- Female vs male athletes
- Female athletesn = 19,069
- Male athletesn = 57,745reference
- Outcome
- Proportions of athlete normal, borderline and abnormal ECG features (2017 International Criteria) and ECG measurements
Methodological detailsrandom-effects model
- Random-effects model
Pooled result
As reported in the abstract
Female athletes vs Male athletesOdds ratio (95% CI)
Abnormal TWI
2.3(1.5–3.5)
Isolated TWIV1-V3
5.6(3.2–9.9)
Abnormal ECG per International Criteria; not statistically significant
1.3(0.7–2.4)
Female athletes vs Male athletesDifference, ms (95% CI)
Longer QTc interval
16(4–27)
Further pooled results
Diagnosis of a condition associated with sudden cardiac arrest or death among athletes with isolated TWIV1-V3
- Male athletes diagnosed (both arrhythmogenic cardiomyopathy)
- two
- No female athletes diagnosed
Original publication
Sex differences in electrocardiograms of trained athletes: a systematic review and meta-analysis. Eur J Prev Cardiol. Published 20 January 2026. doi:10.
Summarised from the published abstract; every number is checked against it