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Introduction Basketball and football are two sports with the highest incidence of sudden cardiac death (SCD) reported in the literature. Correct identification of high-risk individuals is crucial to reduce the potential of SCD in those harbouring a life-threatening cardiac condition. We sought to describe the ECG characteristics of elite British basketball players and compare the prevalence of ECG abnormalities with a large cohort of elite British football players.Methods A cohort of 310 elite British basketball players at national level (mean age of 18.4 ± 0.9 years) were screened with health questionnaire, ECG and echocardiogram if indicated, between 2021 and 2024. 166 (54%) were male, 148 (48%) were white and 154 (50%) of black ethnicity (African/Caribbean). ECGs were retrospectively analysed according to the International criteria for ECG interpretation in athletes and compared to an age-, ethnicity and sex-matched cohort of elite football players screened through the mandatory Football Association cardiac screening programme.Results 5.2% basketball players were found to have abnormal ECG findings classified by the international criteria compared to 1.8% football players (p <0.0001). Compared to football players, basketball players demonstrated a higher prevalence of abnormal T-wave inversion (TWI) (5.2% vs 1.7%, p <0.0001), abnormal QTc intervals (1% vs 0.3%, p= 0.012), atrial enlargement (4.5% vs 2.2%, p= 0.033), first degree atrioventricular block (6.1% vs 3.2%, p= 0.007) and a greater degree of axis deviation (2.6% vs 1.2%, p= 0.056).Among black athletes, abnormal TWI had equal prevalence in basketball players and football players (4.5% vs 4.1%, p= 1). Black basketball players demonstrated a higher prevalence of right ventricular hypertrophy (2.6% vs 0%, p= 0.141) compared to white counterparts, similar to findings amongst footballers (3.7% vs 2.2%, p= 0.004).White basketball players had a higher prevalence of left ventricular hypertrophy (62.8% vs 55.2% p= 0.218) compared to black counterparts, with similar findings for footballers (24.6% vs 17.2%, p <0.0001). Notably, black basketball players had a lower prevalence of left atrial enlargement (0.6% vs 5.7%, p <0.0001) compared to black footballers. There were no reports of inherited cardiac disease or SCD.Abstract 7-011 Table 1Electrocardiographic features of basketball players by abnormal and borderline featuresAbstract 7-011 Table 2Comparison of electrocardiographic features of British basketballers and footballersConclusions The International criteria identified ECG abnormalities in 5.2% of elite basketball players compared to 1.8% of elite footballers. This study highlights the higher false-positive rates of the ECG among basketball players and that sport-specific ECG criteria should be used to improve the diagnostic rate for cardiac disease in order to optimise cardiovascular care for all subgroups of athletes.