There was a longstanding controversy on the role of resting ECG in the preparticipation examination in athletes, as well as in children and adolescent, in leisure time or top athletes. Besides other arguments, this was due to the limited validity, to the false positive and false negative findings often followed by a thorough clinical examination. However, recent studies from different research groups yielded a significant improvement in establishing ECG criteria in athletes discriminating normal from abnormal or pathological findings in athletes.This in addition is supported and improved by a software-based ECG device considering the new Seattle criteria. These new criteria from the Seattle conference reliably discriminate normal from abnormal findings. Frequent ECG findings in athletes, especially in those engaged in endurance sports showed sinus bradycardia, AV-block and signs of left ventricular hypertrophy.