Should a Law Enforcement Officer (LEO) with normal sinus rhythm, moderate repolarisation disturbances, and normal QTc interval be cleared for full duties despite being asymptomatic?

From the Guidelines

This asymptomatic law enforcement officer (LEO) should not be immediately cleared for full duties without further cardiac evaluation, as the moderate repolarization disturbances require additional investigation to rule out underlying cardiac pathology. The ECG findings of moderate repolarization disturbances, despite a normal sinus rhythm and normal QTc interval, necessitate a thorough cardiac assessment to determine the officer's fitness for duty. According to the American Heart Association electrocardiography and arrhythmias committee guidelines 1, primary repolarization abnormalities, which may be caused by various events including ischemia, myocarditis, drugs, toxins, and electrolyte abnormalities, should be distinguished from secondary repolarization abnormalities that occur as a direct result of changes in ventricular depolarization.

The officer should undergo a cardiology consultation with stress testing (exercise stress test or stress echocardiogram) and possibly an echocardiogram to rule out underlying cardiac conditions such as subclinical coronary artery disease, left ventricular hypertrophy, or a benign early repolarization variant. Key considerations in the evaluation of repolarization abnormalities include:

• The distinction between primary and secondary repolarization abnormalities, as outlined in the guidelines 1
• The potential causes of primary repolarization abnormalities, including ischemia, myocarditis, and electrolyte abnormalities
• The importance of considering the officer's physical demands and high-stress nature of law enforcement work in determining the need for further evaluation

Given the physical demands and high-stress nature of law enforcement work, it's prudent to definitively exclude cardiac pathology before clearing the officer. Once cardiac disease has been ruled out through appropriate testing, the officer can likely return to full duties. The temporary restriction from full duty is a precautionary measure to ensure officer safety, as sudden cardiac events during physically demanding or high-stress situations could be dangerous both to the officer and the public. The guidelines emphasize the importance of careful evaluation of repolarization abnormalities, and in this case, further testing is necessary to determine the underlying cause of the moderate repolarization disturbances 1.

From the Research

Law Enforcement Officer Clearance for Full Duties

• The provided studies do not directly address the clearance of a Law Enforcement Officer (LEO) with normal sinus rhythm, moderate repolarisation disturbances, and normal QTc interval for full duties despite being asymptomatic.
• However, study 2 suggests that ECG screening can be a valuable tool in detecting silent abnormalities with potential for arrhythmia in healthy young adults.
• Study 3 discusses normal variants and "red flag" findings in ECGs for athletes, but does not provide specific guidance for LEOs.
• Study 4 highlights the importance of considering legal, ethical, and logistical responsibilities when conducting ECG screening programs, but does not provide direct guidance on clearance for full duties.
• Study 5 analyzed ECGs of German military aircrew and found extremely low numbers of individuals requiring further investigation, which may suggest that routine ECG screening for asymptomatic individuals in high-hazard occupations may not be necessary.
• Study 6 found that moderate repolarisation disturbances can be secondary to left ventricular hypertrophy (LVH) development, but does not provide direct guidance on clearance for full duties.
• There is no direct evidence to suggest that a LEO with normal sinus rhythm, moderate repolarisation disturbances, and normal QTc interval should or should not be cleared for full duties despite being asymptomatic 6, 2, 3, 4, 5.