Heart rate in athletes

Results of a recent EKG that my son had were summarized as: Marked sinus bradycardia with sinus arrhythmia ST elevation, conider early repolarization
His ventricular rate was 49BPM

He is an athlete who has been dealing with sleep issues which have resulted in mild depression-

His doctor was more concerned with the ventricular rate- He runs a great deal and it was explained that this may be a factor in the slow heart rate-

What could all of this mean and should he be followed up by a cardiologist?

[Cleveland Clinic]

He should have a cardiologist look at his EKG, not because of the bradycardia, because that is very common in athletes, but because of the repolarization abnormality.  Most of the time this is a benign finding, however, there are very rare cases where it might need to be worked up further.  I don't think that your sons bradycardia is causing him to sleep poorly.  HR of 49 is a normal finding in the setting of sinus rhythm.  I would not worry about his ventricular rate at all.  Sinus arrhythmia is a sign of a healthy heart.