Electrocardiographic predictors of left ventricular scar in athletes with right bundle branch block premature ventricular beats

In athletes with right bundle branch block (RBBB) morphology non-sustained ventricular arrhythmias (VAs), the presence of a non-ischaemic left ventricular scar (NLVS) may be highly suspected if one or more of the following electrocardiogram (ECG) characteristics are present at the 12-lead resting ECG: low QRS voltages in limb leads, negative Twaves in inferior leads, negative Twaves in limb leads I–aVL, negative Twaves in precordial leads V4–V6, presence of left posterior fascicular block, presence of pathologic Qwaves, and poor R-wave progression in right precordial leads. This score should be externally validated in a larger population of athletes with VAs.In athletes with RBBB morphology non-sustained Vas, attention should be placed on the 12-lead resting ECG to suspect the presence of an NLVS.In athletes with RBBB VAs and the presence of one or more of the identified ECG characteristics, a cardiac magnetic resonance with late gadolinium enhancement is useful to rule out an NLVS.Graphical Abstract