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Basile P, Soldato N, Pedio E, Siena P, Carella MC, Dentamaro I, Khan Y, Baggiano A, Mushtaq S, Forleo C, Ciccone MM, Pontone G, Guaricci AI. Cardiac magnetic resonance reveals concealed structural heart disease in patients with frequent premature ventricular contractions and normal echocardiography: A systematic review. Int J Cardiol 2024; 412:132306. [PMID: 38950789 DOI: 10.1016/j.ijcard.2024.132306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/27/2024] [Accepted: 06/26/2024] [Indexed: 07/03/2024]
Abstract
Premature ventricular contractions (PVCs) are a common form of arrhythmic events, often representing an idiopathic and benign condition without further therapeutic interventions. However, in certain circumstances PVCs may represent the epiphenomenon of a concealed structural heart disease (SHD). Surface 12‑leads EKG and 24-h dynamic EKG are necessary to assess their main characteristics such as site of origin, frequency and complexity. Echocardiography represents the first-line imaging tool recommended to evaluate cardiac structures and function. Cardiac Magnetic Resonance (CMR) is recognized as a superior modality for detecting structural cardiac alterations, that might evade detection by conventional echocardiography. Moreover, in specific populations such as athletes, CMR may have a crucial role to exclude a concealed SHD and the risk of serious arrhythmic events during sport activity. Some clinical characteristics such as male sex, older age or family history of sudden cardiac death (SCD) or cardiomyopathy, and some electrocardiographic features of PVCs, in particular a right branch bundle block (RBBB) with superior/intermediate axis morphology, the reproducibility of VAs during exercise test (ET) or the evidence of complex ventricular arrhythmias, may warrant a CMR evaluation, due to the high probability of SHD. In this systematic review our objective was to provide an exhaustive overview on the role of CMR in detecting a concealed SHD in patients with high daily burden of PVCs and a normal echocardiographic evaluation, paving the way for a more extensive utilization of CMR in presence of certain high-risk clinical and/or EKG features identified during the diagnostic workup.
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Affiliation(s)
- Paolo Basile
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Nicolò Soldato
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Erika Pedio
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Paola Siena
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Maria Cristina Carella
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Ilaria Dentamaro
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Yamna Khan
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Andrea Baggiano
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Saima Mushtaq
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Cinzia Forleo
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Marco Matteo Ciccone
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy
| | - Gianluca Pontone
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Andrea Igoren Guaricci
- Interdisciplinary Department of Medicine, "Aldo Moro" University School of Medicine, Bari, Italy.
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Ranic I, Jiravsky O, Cesnakova Konecna A, Jiravska Godula B, Pesova P, Chovancik J, Neuwirth R, Sknouril L, Pudil R, Plasek J. Diving Deep into Arrhythmias: Unravelling the Impact of Underwater Environments on Premature Ventricular Complexes in Divers. J Clin Med 2024; 13:5298. [PMID: 39274510 PMCID: PMC11395799 DOI: 10.3390/jcm13175298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 09/04/2024] [Accepted: 09/05/2024] [Indexed: 09/16/2024] Open
Abstract
This review examines the relationship between the physiological demands of diving and premature ventricular complexes (PVCs) in divers. In the general population, some individuals have a greater tendency to experience PVCs, often without awareness or a clear understanding of the triggering factors. With the increasing availability and popularity of both scuba and apnoea diving, more people, including those with a predisposition to PVCs, are engaging in these activities. The underwater environment, with its unique stressors, may increase the risk of arrhythmogenic events, particularly PVCs. Here, we review the prevalence, pathophysiology, and aggravating factors of PVCs in divers, emphasising the need for a comprehensive cardiovascular assessment. Evidence suggests a higher prevalence of PVCs in divers compared with the general population, influenced by factors such as age, dive depth, gas bubbles, cold water immersion, pre-existing cardiovascular diseases, and lifestyle factors. The change in environment during diving could potentially trigger an increased frequency of PVCs, especially in individuals with a pre-existing tendency. We discuss diagnostic strategies, management approaches, and preventive measures for divers with PVCs, noting that although guidelines for athletes can be adapted, individual assessment is crucial. Significant knowledge gaps are identified, highlighting the need for future research to develop evidence-based guidelines and understand the long-term significance of PVCs in divers. This work aims to evaluate potential contributing factors to PVCs in divers and identify individuals who may be at higher risk of experiencing major adverse cardiovascular events (MACEs). This work aims to improve diver safety by promoting collaboration between cardiologists and diving medicine specialists and by identifying key areas for future investigation in this field. This work aims to improve the safety and well-being of divers by understanding the cardiovascular challenges they face, including pressure changes, cold water immersion, and hypoxia. We seek to elucidate the relationship between these challenges and the occurrence of PVCs. By synthesising current evidence, identifying knowledge gaps, and proposing preliminary recommendations, we aim to encourage collaboration between cardiologists and diving medicine specialists to optimise the screening, management, and risk stratification of PVCs in the diving population.
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Affiliation(s)
- Ivan Ranic
- Department of Cardiology, Agel Hospital Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic
- Research Center for Internal and Cardiovascular Diseases, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Otakar Jiravsky
- Department of Cardiology, Agel Hospital Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic
- Faculty of Medicine, Masaryk University, Kamenice 735/5, 625 00 Brno, Czech Republic
| | - Alica Cesnakova Konecna
- Department of Cardiology, Agel Hospital Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic
- Research Center for Internal and Cardiovascular Diseases, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Bogna Jiravska Godula
- Department of Cardiology, Agel Hospital Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic
- Faculty of Medicine, Palacky University, Krizovskeho 511/8, 779 00 Olomouc, Czech Republic
| | - Petra Pesova
- Department of Cardiology, Agel Hospital Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic
- Faculty of Medicine, Palacky University, Krizovskeho 511/8, 779 00 Olomouc, Czech Republic
| | - Jan Chovancik
- Department of Cardiology, Agel Hospital Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic
| | - Radek Neuwirth
- Department of Cardiology, Agel Hospital Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic
- Research Center for Internal and Cardiovascular Diseases, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Libor Sknouril
- Department of Cardiology, Agel Hospital Trinec-Podlesi, Konska 453, 739 61 Trinec, Czech Republic
- Research Center for Internal and Cardiovascular Diseases, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Radek Pudil
- 1st Department of Internal Medicine-Cardioangiology, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 500 03 Hradec Kralove, Czech Republic
| | - Jiri Plasek
- Research Center for Internal and Cardiovascular Diseases, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
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Henning RJ. The differentiation of the competitive athlete with physiologic cardiac remodeling from the athlete with cardiomyopathy. Curr Probl Cardiol 2024; 49:102473. [PMID: 38447749 DOI: 10.1016/j.cpcardiol.2024.102473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 03/08/2024]
Abstract
There are currently 5 million active high school, collegiate, professional, and master athletes in the United States. Regular intense exercise by these athletes can promote structural, electrical and functional remodeling of the heart, which is termed the "athlete's heart." In addition, regular intense exercise can lead to pathological adaptions that promote or worsen cardiac disease. Many of the athletes in the United States seek medical care. Consequently, physicians must be aware of the normal cardiac anatomy and physiology of the athlete, the differentiation of the normal athlete heart from the athlete with cardiomyopathy, and the contemporary care of the athlete with a cardiomyopathy. In athletes with persistent cardiovascular symptoms, investigations should include a detailed history and physical examination, an ECG, a transthoracic echocardiogram, and in athletes in whom the diagnosis is uncertain, a maximal exercise stress test or a continuous ECG recording, and cardiac magnetic resonance imaging or cardiac computed tomography angiography when definition of the coronary anatomy or characterization of the aorta and the aortic great vessels is indicated. This article discusses the differentiation of the normal athlete with physiologic cardiac remodeling from the athlete with hypertrophic, dilated or arrhythmogenic ventricular cardiomyopathy (ACM). The ECG changes in trained athletes that are considered normal, borderline, or abnormal are listed. In addition, the normal echocardiographic measurements for athletes who consistently participate in endurance, power, combined or heterogeneous sports are enumerated and discussed. Algorithms are listed that are useful in the diagnosis of trained athletes with borderline or abnormal echocardiographic measurements suggestive of cardiomyopathies along with the major and minor criteria for the diagnosis of ACM in athletes. Thereafter, the treatment of athletes with hypertrophic, dilated, and arrhythmogenic right ventricular cardiomyopathies are reviewed. The distinction between physiologic changes and pathologic changes in the hearts of athletes has important therapeutic and prognostic implications. Failure by the physician to correctly diagnose an athlete with hypertrophic cardiomyopathy, dilated cardiomyopathy, or ACM, can lead to the sudden cardiac arrest and death of the athlete during training or sports competition. Conversely, an incorrect diagnosis by a physician of cardiac pathology in a normal athlete can lead to an unnecessary restriction of athlete training and competition with resultant significant emotional, psychological, financial, and long-term health consequences in the athlete.
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Lampert R, Chung EH, Ackerman MJ, Arroyo AR, Darden D, Deo R, Dolan J, Etheridge SP, Gray BR, Harmon KG, James CA, Kim JH, Krahn AD, La Gerche A, Link MS, MacIntyre C, Mont L, Salerno JC, Shah MJ. 2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play. Heart Rhythm 2024:S1547-5271(24)02560-8. [PMID: 38763377 DOI: 10.1016/j.hrthm.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
Youth and adult participation in sports continues to increase, and athletes may be diagnosed with potentially arrhythmogenic cardiac conditions. This international multidisciplinary document is intended to guide electrophysiologists, sports cardiologists, and associated health care team members in the diagnosis, treatment, and management of arrhythmic conditions in the athlete with the goal of facilitating return to sport and avoiding the harm caused by restriction. Expert, disease-specific risk assessment in the context of athlete symptoms and diagnoses is emphasized throughout the document. After appropriate risk assessment, management of arrhythmias geared toward return to play when possible is addressed. Other topics include shared decision-making and emergency action planning. The goal of this document is to provide evidence-based recommendations impacting all areas in the care of athletes with arrhythmic conditions. Areas in need of further study are also discussed.
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Affiliation(s)
- Rachel Lampert
- Yale University School of Medicine, New Haven, Connecticut
| | - Eugene H Chung
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Rajat Deo
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Joe Dolan
- University of Utah, Salt Lake City, Utah
| | | | - Belinda R Gray
- University of Sydney, Camperdown, New South Wales, Australia
| | | | | | | | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jack C Salerno
- University of Washington School of Medicine, Seattle, Washington
| | - Maully J Shah
- Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
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Sciarra L, Golia P, Scarà A, Robles AG, De Maio M, Palamà Z, Borrelli A, Di Roma M, D'Arielli A, Calò L, Gallina S, Ricci F, Delise P, Zorzi A, Nesti M, Romano S, Cavarretta E. Electrocardiographic predictors of left ventricular scar in athletes with right bundle branch block premature ventricular beats. Eur J Prev Cardiol 2024; 31:486-495. [PMID: 38198223 DOI: 10.1093/eurjpc/zwae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
AIMS Right bundle branch block (RBBB) morphology non-sustained ventricular arrhythmias (VAs) have been associated with the presence of non-ischaemic left ventricular scar (NLVS) in athletes. The aim of this cross-sectional study was to identify clinical and electrocardiogram (ECG) predictors of the presence of NLVS in athletes with RBBB VAs. METHODS AND RESULTS Sixty-four athletes [median age 39 (24-53) years, 79% males] with non-sustained RBBB VAs underwent cardiac magnetic resonance (CMR) with late gadolinium enhancement in order to exclude the presence of a concealed structural heart disease. Thirty-six athletes (56%) showed NLVS at CMR and were assigned to the NLVS positive group, whereas 28 athletes (44%) to the NLVS negative group. Family history of cardiomyopathy and seven different ECG variables were statistically more prevalent in the NLVS positive group. At univariate analysis, seven ECG variables (low QRS voltages in limb leads, negative T waves in inferior leads, negative T waves in limb leads I-aVL, negative T waves in precordial leads V4-V6, presence of left posterior fascicular block, presence of pathologic Q waves, and poor R-wave progression in right precordial leads) proved to be statistically associated with the finding of NLVS; these were grouped together in a score. A score ≥2 was proved to be the optimal cut-off point, identifying NLVS athletes in 92% of cases and showing the best accuracy (86% sensitivity and 100% specificity, respectively). However, a cut-off ≥1 correctly identified all patients with NLVS (absence of false negatives). CONCLUSION In athletes with RBBB morphology non-sustained VAs, specific ECG abnormalities at 12-lead ECG can help in detecting subjects with NLVS at CMR.
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Affiliation(s)
- Luigi Sciarra
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, piazzale Salvatore Tommasi 1, 67100 Coppito (AQ), Italy
| | - Paolo Golia
- Department of Cardiology, Policlinico Casilino Hospital, Rome, Italy
| | - Antonio Scarà
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, piazzale Salvatore Tommasi 1, 67100 Coppito (AQ), Italy
- Department of Cardiology, San Carlo di Nancy Hospital, Rome, Italy
| | - Antonio Gianluca Robles
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, piazzale Salvatore Tommasi 1, 67100 Coppito (AQ), Italy
| | - Melissa De Maio
- Department of Cardiology, Policlinico Casilino Hospital, Rome, Italy
| | - Zefferino Palamà
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, piazzale Salvatore Tommasi 1, 67100 Coppito (AQ), Italy
| | - Alessio Borrelli
- Department of Cardiology, San Carlo di Nancy Hospital, Rome, Italy
| | - Mauro Di Roma
- Department of Radiology, Policlinico Casilino Hospital, Rome, Italy
| | - Alberto D'Arielli
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, piazzale Salvatore Tommasi 1, 67100 Coppito (AQ), Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino Hospital, Rome, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Pietro Delise
- Division of Cardiology, Hospital 'P. Pederzoli', Peschiera del Garda 37019, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani, 2, Padova 35121, Italy
| | - Martina Nesti
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, piazzale Salvatore Tommasi 1, 67100 Coppito (AQ), Italy
- Fondazione Toscana Gabriele Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Silvio Romano
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, piazzale Salvatore Tommasi 1, 67100 Coppito (AQ), Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, corso della Repubblica 79, 04100 Latina, Italy
- Mediterranea Cardiocentro, Via Orazio, 2, 80122 Napoli, Italy
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Carvalho TD, Freitas OGAD, Chalela WA, Hossri CAC, Milani M, Buglia S, Precoma DB, Falcão AMGM, Mastrocola LE, Castro I, Albuquerque PFD, Coutinho RQ, Brito FSD, Alves JDC, Serra SM, Santos MAD, Colombo CSSDS, Stein R, Herdy AH, Silveira ADD, Castro CLBD, Silva MMFD, Meneghello RS, Ritt LEF, Malafaia FL, Marinucci LFB, Pena JLB, Almeida AEMD, Vieira MLC, Stier Júnior AL. Brazilian Guideline for Exercise Test in the Adult Population - 2024. Arq Bras Cardiol 2024; 121:e20240110. [PMID: 38896581 DOI: 10.36660/abc.20240110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Affiliation(s)
- Tales de Carvalho
- Clínica de Prevenção e Reabilitação Cardiosport, Florianópolis, SC - Brasil
- Universidade do Estado de Santa Catarina, Florianópolis, SC - Brasil
| | | | - William Azem Chalela
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | - Mauricio Milani
- Universidade de Brasília (UnB), Brasília, DF, Brasil
- Hasselt University, Hasselt - Bélgica
- Jessa Ziekenhuis, Hasselt - Bélgica
| | - Susimeire Buglia
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | - Andréa Maria Gomes Marinho Falcão
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | - Iran Castro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | | | | | | | | | - Salvador Manoel Serra
- Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro, RJ - Brasil
| | - Mauro Augusto Dos Santos
- Instituto Nacional de Cardiologia do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
- Linkcare Saúde, Rio de Janeiro, RJ - Brasil
| | | | - Ricardo Stein
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | - Artur Haddad Herdy
- Clínica de Prevenção e Reabilitação Cardiosport, Florianópolis, SC - Brasil
| | - Anderson Donelli da Silveira
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | - Claudia Lucia Barros de Castro
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
- CLINIMEX - Clínica de Medicina de Exercício, Rio de Janeiro, RJ - Brasil
| | | | | | - Luiz Eduardo Fonteles Ritt
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
- Instituto D'Or de Pesquisa e Ensino, Salvador, BA - Brasil
- Hospital Cárdio Pulmonar, Salvador, BA - Brasil
| | - Felipe Lopes Malafaia
- Hospital Samaritano Paulista, São Paulo, SP - Brasil
- UnitedHealth Group Brasil, São Paulo, SP - Brasil
| | - Leonardo Filipe Benedeti Marinucci
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felício Rocho, Belo Horizonte, MG - Brasil
| | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - Arnaldo Laffitte Stier Júnior
- Universidade Federal do Paraná (UFPR), Curitiba, PR - Brasil
- Secretaria Municipal de Saúde Curitiba, Curitiba, PR - Brasil
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Pingitore A, Peruzzi M, Clarich SC, Palamà Z, Sciarra L, Cavarretta E. An overview of the electrocardiographic monitoring devices in sports cardiology: Between present and future. Clin Cardiol 2023; 46:1028-1037. [PMID: 37349944 PMCID: PMC10540029 DOI: 10.1002/clc.24073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Athletes represent a mainly healthy population, which however could be considered at risk of major arrhythmic events, especially in case of undiagnosed cardiomyopathies. For this reason, the periodical sports medicine examination and the electrocardiography are essential tools in the cardiovascular screening, even though they do not always succeed in identifying rhythm disturbances, particularly when asymptomatic or rarely symptomatic. HYPOTHESIS Prolonged cardiac monitoring often enables clinicians to stratify the arrhythmic risk and reach the diagnosis. The technological progress of the last decades has produced an always-increasing number of heart rhythm monitoring devices, starting from the 24-hour electrocardiogram Holter monitoring and ending with the wide world of wearable devices. METHODS In the literature, the extreme utility of this equipment in the patients affected by cardiovascular diseases and in the general population is well established. On the contrary, athletes-based randomized trials or large-scale epidemiological studies targeting the frequency of cardiac symptoms and the use of cardiac monitoring are missing, while an ever-growing number of case series and small observational studies are flourishing in recent years. RESULTS The present review showcases the available electrocardiographic monitoring options, principally in the medical setting, listing their characteristics, their indications, their supporting evidence, and their general pros and cons. CONCLUSIONS The ultimate goal of this review is guiding physicians through the wide variety of heart rhythm monitoring options in the specific subfield of sports cardiology, when an arrhythmia is suspected in an athlete, to tailor the diagnostic process and favor the best diagnostic accuracy.
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Affiliation(s)
- Annachiara Pingitore
- Department of General and Specialistic Surgery “Paride Stefanini”Sapienza University of RomeRomeItaly
| | - Mariangela Peruzzi
- Department of Clinical Internal, Anesthesiology and Cardiovascular SciencesSapienza University of RomeRomeItaly
- Mediterranea CardiocentroNaplesItaly
| | | | - Zefferino Palamà
- Electrophysiology Service, Division of CardiologyCasa di Cura Villa VerdeTarantoItaly
- Department of Clinical Medicine, Public Health, Life and Environmental SciencesUniversity of L'AquilaCoppitoItaly
| | - Luigi Sciarra
- Department of Clinical Medicine, Public Health, Life and Environmental SciencesUniversity of L'AquilaCoppitoItaly
| | - Elena Cavarretta
- Mediterranea CardiocentroNaplesItaly
- Department of Medical‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
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Graziano F, Mastella G, Merkely B, Vago H, Corrado D, Zorzi A. Ventricular arrhythmias recorded on 12-lead ambulatory electrocardiogram monitoring in healthy volunteer athletes and controls: what is common and what is not. Europace 2023; 25:euad255. [PMID: 37589170 PMCID: PMC10469403 DOI: 10.1093/europace/euad255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/29/2023] [Accepted: 08/14/2023] [Indexed: 08/18/2023] Open
Abstract
AIMS Premature ventricular beats (PVBs) in athletes are often benign, but sometimes they may be a sign of an underlying disease. We evaluated the prevalence, burden, and morphology of PVBs in healthy voluntary athletes and controls with the main purpose of defining if certain PVB patterns are 'common' and 'training related' and, as such, are more likely benign. METHODS AND RESULTS We studied 433 healthy competitive athletes [median age 27 (18-43) years, 74% males] and 261 age- and sex-matched sedentary subjects who volunteered to undergo 12-lead 24 h ambulatory electrocardiogram (ECG) monitoring (24H ECG), with a training session in athletes. Ventricular arrhythmias (VAs) were evaluated in terms of their number, complexity [i.e. couplet, triplet, or non-sustained ventricular tachycardia (NSVT)], exercise inducibility, and morphology. Eighty-six percent of athletes and controls exhibited a total of ≤10 PVBs/24 h, and >90% did not show any couplets, triplets, or runs of NSVT > 3 beats. An higher number of PVBs correlated with increasing age (P < 0.01) but not with sex and level of training. The most frequent morphologies among the 36 athletes with >50 PVBs were the infundibular (44%) and fascicular (22%) ones. In a comparison between athletes and sedentary individuals, and male and female athletes, no statistically significant differences were found in PVBs morphologies. CONCLUSION The prevalence and complexity of VAs at 24H ECG did not differ between athletes and sedentary controls and were not related to the type and amount of sport or sex. Age was the only variable associated with an increased PVB burden. Thus, no PVB pattern in the athlete can be considered 'common' or 'training related'.
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Affiliation(s)
- Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Giulio Mastella
- Klinikum Rechts der Isar-Innere Medizin I, Technische Universität München, Munchen, Germany
| | - Bela Merkely
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Hajnalka Vago
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
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9
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Calò L, Panattoni G, Tatangelo M, Brunetti G, Graziano F, Monzo L, Danza ML, Fedele E, Grieco D, Crescenzi C, Rebecchi M, Stazi A, Bressi E, De Ruvo E, Golia P, Gaita F, Corrado D, Zorzi A. Electrocardiographic characteristics of right-bundle-branch-block premature ventricular complexes predicting absence of left ventricular scar in athletes with apparently structural normal heart. Europace 2023; 25:euad217. [PMID: 37466354 PMCID: PMC10374981 DOI: 10.1093/europace/euad217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023] Open
Abstract
AIMS Left ventricular scar is an arrhythmic substrate that may be missed by echocardiography and diagnosed only by cardiac magnetic resonance (CMR), which is a time-consuming and expensive imaging modality. Premature ventricular complexes (PVCs) with a right-bundle-branch-block (RBBB) pattern are independent predictors of late gadolinium enhancement (LGE) but their positive predictive value is low. We studied which electrocardiographic features of PVCs with an RBBB pattern are associated with a higher probability of the absence of an underlying LGE. METHODS The study included 121 athletes (36 ± 16 years; 48.8% men) with monomorphic PVCs with an RBBB configuration and normal standard clinical investigations who underwent CMR. LGE was identified in 35 patients (29%), predominantly in those with PVCs with a superior/intermediate axis (SA-IntA) compared to inferior axis (IA) (38% vs. 10%, P = 0.002). Among patients with SA-IntA morphology, the contemporary presence of qR pattern in lead aVR and V1 was exclusively found in patients without LGE at CMR (51.0% vs. 0%, P < 0.0001). Among patients with IA, the absence of LGE correlated to a narrow ectopic QRS (145 ± 16 vs. 184 ± 27 msec, P < 0.001). CONCLUSIONS Among athletes with apparently idiopathic PVCs with a RBBB configuration, the presence of a concealed LGE at CMR was documented in 29% of cases, mostly in those with a SA-IntA. In our experience, the contemporary presence of qR pattern in lead aVR and V1 in PVCs with RBBB/SA-IntA morphology or, on the other hand, a relatively narrow QRS in PVCs with an IA, predicted absence of LGE.
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Affiliation(s)
- Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Germana Panattoni
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Mario Tatangelo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Giulia Brunetti
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Luca Monzo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
- Université de Lorraine INSERM, Centre d’ Investigations Cliniques Plurithématique, Nancy, France
| | - Maria Ludovica Danza
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Elisa Fedele
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Domenico Grieco
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Cinzia Crescenzi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Marco Rebecchi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Alessandra Stazi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Edoardo Bressi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Ermenegildo De Ruvo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Paolo Golia
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, AOU Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
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10
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Dello Russo A, Compagnucci P, Zorzi A, Cavarretta E, Castelletti S, Contursi M, D'Aleo A, D'Ascenzi F, Mos L, Palmieri V, Patrizi G, Pelliccia A, Sarto P, Delise P, Zeppilli P, Romano S, Palamà Z, Sciarra L. Electroanatomic mapping in athletes: Why and when. An expert opinion paper from the Italian society of sports cardiology. Int J Cardiol 2023:S0167-5273(23)00702-7. [PMID: 37178805 DOI: 10.1016/j.ijcard.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/21/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
Three-dimensional electroanatomical mapping (EAM) has the potential to identify the pathological substrate underlying ventricular arrhythmias (VAs) in different clinical settings by detecting myocardial areas with abnormally low voltages, which reflect the presence of different cardiomyopathic substrates. In athletes, the added value of EAM may be to enhance the efficacy of third-level diagnostic tests and cardiac magnetic resonance (CMR) in detecting concealed arrhythmogenic cardiomyopathies. Additional benefits of EAM in the athlete include the potential impact on disease risk stratification and the consequent implications for eligibility to competitive sports. This opinion paper of the Italian Society of Sports Cardiology aims to guide general sports medicine physicians and cardiologists on the clinical decision when to eventually perform an EAM study in the athlete, highlighting strengths and weaknesses for each cardiovascular disease at risk of sudden cardiac death during sport. The importance of early (preclinical) diagnosis to prevent the negative effects of exercise on phenotypic expression, disease progression, and worsening of the arrhythmogenic substrate is also addressed.
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Affiliation(s)
- Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Lancisi-Umberto I- Salesi", Ancona, Italy, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Lancisi-Umberto I- Salesi", Ancona, Italy, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Naples, Italy
| | - Silvia Castelletti
- Department of Cardiology, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Maurizio Contursi
- Division of Cardiology, Hospital of Peschiera del Garda, Veneto, Italy
| | | | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Lucio Mos
- San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | - Vincenzo Palmieri
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | | | | | - Paolo Zeppilli
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Aquila, Italy
| | - Zefferino Palamà
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Aquila, Italy; Casa di Cura Villa Verde, Taranto, Italy.
| | - Luigi Sciarra
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Aquila, Italy
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11
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Milovančev A, Miljković T, Ilić A, Stojšić Milosavljević A, Petrović M, Roklicer R, Lakičević N, Trivić T, Drid P. Disrupting arrhythmia in a professional male wrestler athlete after rapid weight loss and high-intensity training-Case report. Front Cardiovasc Med 2023; 10:1091603. [PMID: 36760566 PMCID: PMC9905426 DOI: 10.3389/fcvm.2023.1091603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction Physiological heart adaptations may lead to increased susceptibility to arrhythmia in athletes. Furthermore, vigorous training and method like rapid weight loss (RWL) in combat sports could pose additional risks. This case represents how routine cardiovascular screening during high-risk methods like RWL and high-intensity training (HIT) reveal abrupt ventricular arrhythmias in a young athlete. Case report We report a case of a 20-year-old male wrestler athlete who developed disrupting arrhythmia during RWL and HIT. The study included: a medical exam, 12 lead electrocardiograms (ECG), transthoracic echocardiogram (ECHO), and 24 h of continuous ECG monitoring in baseline, phase one (P1), (in which the athlete had to simulate RWL through vigorous training and dietary intervention and HIT) and phase two (P2), (with the same HIT protocol performed without the RWL procedure). Baseline laboratory analyses were without abnormalities, ECG showed sinus rhythm with one premature atrial contraction (PAC) and ECHO showed signs of concentric remodeling with preserved systolic, diastolic function, and global longitudinal strain. After P1 RWL simulation, he lost 5.15% of body weight in 3 days, which resulted in lower blood glucose levels, higher urea, creatinine, creatine kinase (CK), CK-MB levels, and slightly increased levels of NT pro-BNP, ECG revealed sinus rhythm with one ventricular premature beat (VPB), 24-h continuous electrocardiogram (ECG) revealed frequent ventricular premature beats (PVB) 2,150/ 24 h, with two couplets, and 8 PAC. After an advised 4-week period of de-training continuous 24 h, ECG monitoring was improved with only occasional PVB. The 24 h continuous ECG monitoring was repeated after HIT and revealed even more frequent PVB, 5% of all beats for 24 h, 4,205 in total, and almost all VPB were in bigeminy and trigeminy. The athlete was advised against RWL and extremely vigorous exercise and for regular, frequent checkups with occasional ECG monitoring during and after exercise. Conclusion The short and long-term implication of abrupt ventricular arrhythmias provoked by intensive training and methods like RWL is unknown. We postulate that cardiovascular screening is necessitated, especially during high-risk methods like RWL and HIT, in helping us prevent adverse outcomes and come to individual-based clinical making decisions for each athlete.
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Affiliation(s)
- Aleksandra Milovančev
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia,Department of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia,*Correspondence: Aleksandra Milovančev ✉
| | - Tatjana Miljković
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia,Department of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Aleksandra Ilić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia,Department of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Anastazija Stojšić Milosavljević
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia,Department of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Milovan Petrović
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia,Department of Cardiology, Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia,Milovan Petrović ✉
| | - Roberto Roklicer
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Nemanja Lakičević
- Sport and Exercise Sciences Research Unit, University of Palermo, Palermo, Italy
| | - Tatjana Trivić
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
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12
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Vriz O, Landi I, Eltayeb A, Limongelli G, Mos L, Delise P, Bossone E, Andrea AD. Mitral Valve Prolapse and Sudden Cardiac Death in Athletes at High Risk. Curr Cardiol Rev 2023; 19:e201222212066. [PMID: 36545732 PMCID: PMC10280998 DOI: 10.2174/1573403x19666221220163431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/23/2022] [Accepted: 10/31/2022] [Indexed: 12/24/2022] Open
Abstract
Mitral valve prolapse (MVP) is the most frequent valvulopathy in the general population, with usually a favourable prognosis. Although it can be associated with some complications, ventricular arrhythmias (VA) and sudden cardiac death (SCD) are the most worrying. The estimated risk of SCD in MVP is between 0.2% to 1.9% per year, including MVP patients with and without severe mitral regurgitation (MR). The association between SCD and MVP is expressed by a phenotype called "malignant MVP" characterized by transthoracic echocardiography (TTE) findings such as bileaflet myxomatous prolapse and mitral annulus disjunction (MAD), ECG findings such as repolarization abnormalities, complex ventricular arrhythmias (c-VAs) and LV fibrosis of papillary muscles (PMs) and inferobasal wall visualized by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Therefore, attention is raised for patients with "arrhythmic MVP" characterized from an ECG point of view by frequent premature ventricular contractions (PVCs) arising from one or both PMs as well as by T-wave inversion in the inferolateral leads. In athletes, SCD is the most frequent medical cause of death and in young subjects (< 35 years) usually is due to electrical mechanism affecting who has a silent cardiovascular disease and are not considered per se a cause of increased mortality. In MVP, SCD was reported to happen during sports activity or immediately after and valve prolapse was the only pathological aspect detected. The aim of the present paper is to explore the association between SCD and MVP in athletes, focusing attention on ECG, TTE in particular, and CMR findings that could help to identify subjects at high risk for complex arrhythmias and eventually SCD. In addition, it is also examined if sports activity might predispose patients with MVP to develop major arrhythmias.
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Affiliation(s)
- Olga Vriz
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Irene Landi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Abdalla Eltayeb
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, Inherited and Rare Cardiovascular Disease Unit, University of Campania “Luigi Vanvitelli”, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Lucio Mos
- Dipartimento di Cardiologia, Ospedale San Daniele del Friuli, Udine, Italy
| | | | - Eduardo Bossone
- Azienda Ospedaliera di Rilevanza Nazionale “A. Cardarelli” Hospital, Naples, Italy
| | - Antonello D` Andrea
- Department of Cardiology, Umberto I Hospital, Luigi Vanvitelli University - Nocera Inferiore (ASL Salerno), Caserta, Italy
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13
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Ujeyl A, Niederseer D. [The athlete's ECG : What is normal or abnormal?]. Herzschrittmacherther Elektrophysiol 2023; 34:10-18. [PMID: 36670183 PMCID: PMC9950162 DOI: 10.1007/s00399-022-00917-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/12/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND The electrocardiogram (ECG) has become a mobile and cost-effective routine assessment tool to risk stratify leisure-time and professional athletes during preparticipation screening. A central goal is the reduction of sudden cardiac death in sports through early recognition of the most prevalent underlying cardiac pathologies, e.g., hereditary cardiomyopathies or primary arrhythmias. METHODS Continuous evolution of the first ECG criteria for athletes, presented in 2010 by the European Society of Cardiology (ESC), has helped to improve the specificity of the criteria to both detect cardiac pathologies in early stages and differentiate from physiologic adaptation of the athlete's heart. Thus, the risk of false-positive findings and erroneous stigmatizations of athletes has been successfully reduced. CONCLUSION This review article intends to trace back the changes of the ECG criteria in the light of a growing body of scientific evidence over the last 15 years, to present the key messages of the current International ECG criteria from 2017 and to identify some of the remaining challenges that wait to be answered by physicians in the field of sports medicine and sports cardiology.
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Affiliation(s)
- Amaar Ujeyl
- Praxis LANS Cardio, Hamburg, Deutschland ,grid.264200.20000 0000 8546 682XMSc Sports Cardiology, St. George’s University of London, London, Großbritannien
| | - David Niederseer
- Klinik für Kardiologie, Universitäres Herzzentrum Zürich, Universitätsspital Zürich, Universität Zürich, Rämistrasse 100, Zürich, 8091, Schweiz.
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14
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Pietrzak R, Łuczak-Woźniak K, Książczyk TM, Werner B. Cardiopulmonary capacity is reduced in children with ventricular arrhythmia. Heart Rhythm 2022; 20:554-560. [PMID: 36566888 DOI: 10.1016/j.hrthm.2022.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Premature ventricular contractions (PVCs) are frequently seen in children and are considered benign. A substantial group of adolescents with PVCs complain about a broad range of clinical symptoms, including low exertion tolerance. OBJECTIVE The purpose of this study was to evaluate prospectively whether ventricular arrhythmia affects physical performance in adolescents with normal left ventricular function, using a cardiopulmonary exercise test (CPET) and evaluating the electrocardiographic (ECG) characteristics of patients with PVCs with regard to exercise capacity. METHODS The study group consisted of 49 children with PVCs and normal left ventricular function. The control group consisted of 36 healthy volunteers. Standard ECG, 24-hour Holter ECG, and CPET were performed. PVCs were analyzed for QRS duration, bundle branch block pattern, QRS axis, and coupling interval (CInt). For CPET, heart rate (HR), oxygen uptake (VO2max), predicted VO2max, and VO2max expressed as a percentage of the predicted value (%VO2) were measured. RESULTS In 37 patients (76%), arrhythmia subsided during exercise. Patients achieved lower VO2max (32.9 ± 6.3 mL/min/kg) than controls (40.4 ± 6.7 mL/min/kg; P <.01). %VO2 was 71.0 ± 13.7 in patients and 79.3 ± 12.2 in controls (P <.01). Exercise HR at which PVCs subsided correlated with VO2max (r = 0.3; P = .07). Patients with persisting arrhythmia performed worse than those in whom arrhythmia subsided during exercise (VO2max, P <.01; %VO2,P <.01). No correlation between QRS and CInt parameters and VO2max was observed. CONCLUSION Patients with PVCs have lower aerobic capacity than their healthy peers. Further worsening of exercise capacity is present when PVCs are preserved during effort.
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Affiliation(s)
- Radosław Pietrzak
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland.
| | - Katarzyna Łuczak-Woźniak
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz M Książczyk
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland
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15
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Valenzuela PL, Baggish A, Castillo-García A, Santos-Lozano A, Boraita A, Lucia A. Strenuous Endurance Exercise and the Heart: Physiological versus Pathological Adaptations. Compr Physiol 2022; 12:4067-4085. [PMID: 35950659 DOI: 10.1002/cphy.c210045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Although the benefits of regular physical activity on cardiovascular health are well established, the effects of strenuous endurance exercise (SEE) have been a matter of debate since ancient times. In this article, we aim to provide a balanced overview of what is known about SEE and the heart-from epidemiological evidence to recent cardiac imaging findings. Lifelong SEE is overall cardioprotective, with endurance master athletes showing in fact a youthful heart. Yet, some lines of research remain open, such as the need to elucidate the time-course and potential relevance of transient declines in heart function (or increases in biomarkers of cardiac injury) with SEE. The underlying mechanisms and clinical relevance of SEE-associated atrial fibrillation, myocardial fibrosis, or high coronary artery calcium scores also remain to be elucidated. © 2022 American Physiological Society. Compr Physiol 12:1-19, 2022.
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Affiliation(s)
- Pedro L Valenzuela
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Adrián Castillo-García
- Fissac - Physiology, Health and Physical Activity, Madrid, Spain.,Biology Systems Department, University of Alcalá, Madrid, Spain
| | - Alejandro Santos-Lozano
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain.,i+HeALTH, European University Miguel de Cervantes, Valladolid, Spain
| | - Araceli Boraita
- Department of Cardiology, Sports Medicine Center, Spanish Agency for Health Protection in Sports, Madrid, Spain
| | - Alejandro Lucia
- Physical Activity and Health Research Group ('PaHerg'), Research Institute of the Hospital 12 de Octubre ('imas12'), Madrid, Spain.,Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
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16
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Boraita A, Heras ME, Valenzuela PL, Diaz-Gonzalez L, Morales-Acuna F, Alcocer-Ayuga M, Bartolomé-Mateos S, Santos-Lozano A, Lucia A. Holter-determined arrhythmias in young elite athletes with suspected risk: Insights from a 20-year experience. Front Cardiovasc Med 2022; 9:896148. [PMID: 35935632 PMCID: PMC9354520 DOI: 10.3389/fcvm.2022.896148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeWe assessed the occurrence of rhythm alterations in elite athletes with suspected risk using Holter monitoring, and the association of Holter-determined rhythm alterations with echocardiographic findings.MethodsA large cohort of Spanish elite athletes (N = 6,579, 34% female) underwent in-depth cardiological examination (including echocardiographic evaluation, and resting and exercise electrocardiogram [ECG]) between 01/02/1998 and 12/31/2018. Holter monitoring was performed in those reporting cardiovascular symptoms, with suspicion of cardiac structural abnormalities potentially associated with dangerous arrhythmias, or with resting/exercise ECG features prompting a closer examination. We assessed the occurrence of cardiac rhythm alterations, as well as the association between echocardiography-determined conditions and rhythm alterations.ResultsMost athletes (N = 5925) did not show any sign/symptom related to arrhythmia (including normal resting and exercise/post-exercise ECG results) whereas 9.9% (N = 654; 28% female; median age, 24 years [interquartile range 19–28]; competition experience [mean ± SD] 10±6 years) met the criteria to undergo Holter monitoring. Among the latter, sinus bradycardia was the most common finding (present in 96% of cases), yet with a relatively low proportion of severe (<30 bpm) bradycardia (12% of endurance athletes during night-time). Premature atrial and ventricular beats were also common (61.9 and 39.4%, respectively) but sinus pauses ≥3 s, high-grade atrioventricular blocks, and atrial fibrillation/flutter were rare (<1%). Polymorphic premature ventricular contractions (PVC, 1.4%) and idioventricular rhythm (0.005%) were also rare. PVC couplets were relatively prevalent (10.7%), but complex ventricular arrhythmias were not frequent (PVC triplets: 1.8%; sustained ventricular tachycardia: 0.0%; and nonsustained ventricular tachycardia: 1.5%). On the other hand, no associations were found between arrhythmias (including their different morphologies) and major cardiac structural alterations (including mitral prolapse). However, an association was found between mild mitral regurgitation and supraventricular (odds ratio 2.61; 95% confidence interval 1.08–6.32) and ventricular (2.80; 1.15–6.78; p = 0.02) arrhythmias, as well as between mild or moderate mitral regurgitation and ventricular arrhythmias (2.49; 1.03–6.01).ConclusionsIrrespective of the sports discipline, “dangerous” ventricular arrhythmias are overall infrequent even among young elite athletes who require Holter monitoring due to the presence of symptoms or abnormal echocardiographic/ECG findings, and do not seem to be associated with underlying serious cardiac structural pathologies.
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Affiliation(s)
- Araceli Boraita
- Department of Cardiology, Sports Medicine Center, Consejo Superior de Deportes, Madrid, Spain
- *Correspondence: Araceli Boraita
| | - María-Eugenia Heras
- Department of Cardiology, Sports Medicine Center, Consejo Superior de Deportes, Madrid, Spain
| | - Pedro L. Valenzuela
- Research Institute of the Hospital 12 de Octubre (“imas12”, PaHerg group), Madrid, Spain
| | - Leonel Diaz-Gonzalez
- Department of Cardiology, CEMTRO Clinic, Madrid, Spain
- Department of Cardiology, La Paz Hospital, Madrid, Spain
| | - Francisco Morales-Acuna
- Especialidad en Medicina del Deporte y la Actividad Física, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
| | - María Alcocer-Ayuga
- Department of Cardiology, Sports Medicine Center, Consejo Superior de Deportes, Madrid, Spain
| | - Sonia Bartolomé-Mateos
- Department of Cardiology, Sports Medicine Center, Consejo Superior de Deportes, Madrid, Spain
| | - Alejandro Santos-Lozano
- Research Institute of the Hospital 12 de Octubre (“imas12”, PaHerg group), Madrid, Spain
- Department of Health Sciences, i+HeALTH Research Group, European University Miguel de Cervantes, Valladolid, Spain
| | - Alejandro Lucia
- Research Institute of the Hospital 12 de Octubre (“imas12”, PaHerg group), Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
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17
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Patel N, Pena C, Nesheiwat Z, Zafrullah F, Eltahawy E. Ventricular fibrillation arrest after blunt chest trauma in a 33-year-old man, commotio cordis? BMC Cardiovasc Disord 2022; 22:252. [PMID: 35658897 PMCID: PMC9166514 DOI: 10.1186/s12872-022-02689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background Commotio cordis is an event in which a blunt, non-penetrating blow to the chest occurs, triggering a life-threatening arrhythmia and often sudden death. This phenomenon is often seen in young, male athletes and has become increasingly well-known over the past few decades. We present a unique case in which ventricular fibrillation occurs in an older male athlete after blunt trauma. Case presentation Patient with no known medical history was brought to the ER after being found unconscious after a soccer ball kick to the chest. He was found to be in ventricular fibrillation and successfully resuscitated on the soccer field. Patient was admitted to the hospital and lab workup and initial imaging were unremarkable, except elevated troponin and lactate, which returned to normal levels. An echocardiogram showed global left ventricular systolic dysfunction with a visually estimated ejection fraction of 45–50%. Coronary showed angiographically nonobstructive coronary arteries. The patient was diagnosed with commotio cordis and discharged from the hospital in stable condition. Follow-up echocardiogram continued to show low ejection fraction and event monitor demonstrated frequent polymorphic ventricular tachycardia with periods of asystole. Conclusion This case is unique in that blunt trauma to the chest from a soccer ball immediately triggered ventricular fibrillation in a patient with a possible cardiomyopathy. It is possible that the blunt trauma caused primary commotio cordis that led to cardiomyopathy in a previous healthy man, or that an underlying cardiomyopathy made it more likely for this to occur. Overall, increased awareness and prevention efforts of blunt chest trauma are required to reduce the high mortality associated life-threatening arrhythmias. There is limited data regarding the interplay between these two entities.
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Affiliation(s)
- Neha Patel
- Department of Internal Medicine, The University of Toledo, 3000 Arlington Avenue, Toledo, OH, 43614, USA. .,Department of Internal Medicine, The University of Toledo, 2100 W. Central Ave, Toledo, OH, 43614, USA.
| | - Clarissa Pena
- Department of Internal Medicine, The University of Toledo, 3000 Arlington Avenue, Toledo, OH, 43614, USA
| | - Zeid Nesheiwat
- Department of Cardiovascular Medicine, The University of Toledo, 3000 Arlington Avenue, Toledo, OH, 43614, USA
| | - Fnu Zafrullah
- Department of Cardiovascular Medicine, The University of Toledo, 3000 Arlington Avenue, Toledo, OH, 43614, USA
| | - Ehab Eltahawy
- Department of Cardiovascular Medicine, The University of Toledo, 3000 Arlington Avenue, Toledo, OH, 43614, USA
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18
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Norouzi J, Papadakis M, Akbarnejad A, Anvari M. The role of pre-participation cardiac evaluation in the management of an athlete with premature ventricular contraction-induced cardiomyopathy: a case report. Eur Heart J Case Rep 2022; 6:ytac174. [PMID: 35582543 PMCID: PMC9108534 DOI: 10.1093/ehjcr/ytac174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/03/2021] [Accepted: 04/19/2022] [Indexed: 11/16/2022]
Abstract
Background Premature ventricular contractions (PVCs) are commonly observed during pre-participation cardiac screening in elite athletes. There is an ongoing debate about the clinical significance of PVCs in athletes and whether burden, morphology, or both should be used to differentiate benign PVCs from PVCs suggestive of cardiac disease. Case summary A 28-year-old male athlete was evaluated as part of the pre-participation screening programme. He was asymptomatic, without specific cardiac signs and symptoms. A 12-lead electrocardiogram showed bigeminy PVCs with infundibular morphology and left ventricular outflow tract origin. Left ventricular dilatation and systolic dysfunction without valvular lesions was detected on echocardiography. Cardiac magnetic resonance imaging showed biventricular dilatation and dysfunction without evidence of myocardial fibrosis or fatty infiltration. A 48 h Holter monitoring showed 75191 PVCs (35% of total beats). Radiofrequency ablation was performed, and post-ablation assessments showed no PVCs with normalized ventricular function and dimension. Discussion This case demonstrated that a high PVC burden of common morphology does not also represent a benign finding and requires a comprehensive evaluation to rule out any pathological condition. Furthermore, the present case highlights the critical role of pre-participation cardiac evaluation in identifying cardiac disease in asymptomatic athletes.
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Affiliation(s)
- Javad Norouzi
- Department of Exercise Physiology, University of Tehran, Tehran, Iran
- Sports Cardiology Department, National Olympic Academy, Tehran, Iran
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St. George’s, University of London, London, UK
| | - Ali Akbarnejad
- Department of Exercise Physiology, University of Tehran, Tehran, Iran
| | - Mehdi Anvari
- Sports Cardiology Department, National Olympic Academy, Tehran, Iran
- Corresponding authors: Tel: +98 9122494263,
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19
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Fyyaz S, Papadakis M. Arrhythmogenesis of Sports: Myth or Reality? Arrhythm Electrophysiol Rev 2022; 11:e05. [PMID: 35734145 PMCID: PMC9194918 DOI: 10.15420/aer.2021.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/17/2022] [Indexed: 11/09/2022] Open
Abstract
Regular exercise confers health benefits with cardiovascular mortality risk reduction through a variety of mechanisms. At a population level, evidence suggests that undertaking more exercise has greater benefits. In the modern era of sport, there has been an exponential rise in professional and amateur athletes participating in endurance events, with a progressively better understanding of the associated cardiac adaptations, collectively termed 'athletes heart'. However, emerging data raise questions regarding the risk of potential harm from endurance exercise, with an increased risk of arrhythmia from adverse cardiac remodelling. Cross-sectional studies have demonstrated that athletes may exhibit a higher burden of AF, conduction tissue disease, ventricular arrhythmias, a cardiomyopathy-like phenotype and coronary artery disease. In an attempt to separate myth from reality, this review reports on the evidence supporting the notion of 'too much exercise', the purported mechanisms of exercise-induced cardiac arrhythmia and complex interplay with sporting discipline, demographics, genetics and acquired factors.
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Affiliation(s)
- Saad Fyyaz
- Cardiovascular Clinical Academic Group, St George's, University of London, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's, University of London, St George's University Hospitals NHS Foundation Trust, London, UK
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20
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Zorzi A, Moreschi C, Basso C, Thiene G. Sudden death of an athlete due to concealed arrhythmogenic cardiomyopathy: Why preparticipation screening did fail. Int J Cardiol 2022:S0167-5273(22)00319-9. [PMID: 35248625 DOI: 10.1016/j.ijcard.2022.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/20/2022]
Abstract
We report the case of a professional soccer athlete who died suddenly for arrhythmogenic cardiomyopathy that was not diagnosed at the time of preparticipation screening. Exercise testing had repeatedly shown effort-induced premature ventricular beats with normal echocardiography, which was considered reassuring. However, there is emerging evidence that cardiac diseases characterized by focal ventricular scarring may not cause wall motion abnormalities and can be revealed only by tissue characterization with cardiac magnetic resonance. Modern interpretation of premature ventricular beats features is essential to select athletes who should undergo advanced cardiac imaging investigations, to achieve a correct diagnosis and allow safe sport participation.
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Affiliation(s)
- Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy
| | - Carlo Moreschi
- Department of Medicine, Section of Forensic Medicine, University of Udine
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy.
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21
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Brunetti G, Cipriani A, Perazzolo Marra M, De Lazzari M, Bauce B, Calore C, Rigato I, Graziano F, Vio R, Corrado D, Zorzi A. Role of Cardiac Magnetic Resonance Imaging in the Evaluation of Athletes with Premature Ventricular Beats. J Clin Med 2022; 11:426. [PMID: 35054118 PMCID: PMC8781801 DOI: 10.3390/jcm11020426] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/18/2021] [Accepted: 01/06/2022] [Indexed: 12/19/2022] Open
Abstract
Premature ventricular beats (PVBs) in athletes are not rare. The risk of PVBs depends on the presence of an underlying pathological myocardial substrate predisposing the subject to sudden cardiac death. The standard diagnostic work-up of athletes with PVBs includes an examination of family and personal history, resting electrocardiogram (ECG), 24 h ambulatory ECG (possibly with a 12-lead configuration and including a training session), maximal exercise testing and echocardiography. Despite its fundamental role in the diagnostic assessment of athletes with PVBs, echocardiography has very limited sensitivity in detecting the presence of non-ischemic left ventricular scars, which can be revealed only through more in-depth studies, particularly with the use of contrast-enhanced cardiac magnetic resonance (CMR) imaging. The morphology, complexity and exercise inducibility of PVBs can help estimate the probability of an underlying heart disease. Based on these features, CMR imaging may be indicated even when echocardiography is normal. This review focuses on interpreting PVBs, and on the indication and role of CMR imaging in the diagnostic evaluation of athletes, with a special focus on non-ischemic left ventricular scars that are an emerging substrate of cardiac arrest during sport.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (G.B.); (A.C.); (M.P.M.); (M.D.L.); (B.B.); (C.C.); (I.R.); (F.G.); (R.V.); (A.Z.)
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22
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Abstract
Hereditary diseases under the age of 35 are the most common underlying heart disease, leading to sudden cardiac death (SCD) in competitive sports, while in older people, atherosclerotic coronary artery disease (CAD) is the main cause. The following preventive measures are recommended: (a) The pre-participation cardiovascular screening, (b) the genetic testing, (c) the use of implantable cardioverter-defibrillator (ICD), (d) the prohibition of doping in sports, (e) the prevention of 'exercise-induced' cardiac complications, (f) the reduction of high-risk factors for CAD, and (g) the use of cardiopulmonary resuscitation. The cost-effectiveness of the electrocardiograms in the pre-participation screening programs remains questionable. Genetic testing is recommended in borderline cases and positive family history. Athletes with ICD can, under certain conditions, participate in competitive sports. Excessive endurance exercise appears to harm the endothelium, promotes inflammatory processes and leads to fibrosis in the myocardium, and calcium deposition in the coronary vessels. Cardiac arrest may be reversed if cardiopulmonary resuscitation is performed and a defibrillator is immediately used. Thus, equipping all fields with automatic external defibrillators are recommended.
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Affiliation(s)
- Asterios Deligiannis
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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23
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Gao LL, Wu CH. Transient ventricular arrhythmia as a rare cause of dizziness during exercise: A case report. World J Clin Cases 2021; 9:9205-9210. [PMID: 34786406 PMCID: PMC8567521 DOI: 10.12998/wjcc.v9.i30.9205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/24/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dizziness is a common symptom in adults and usually due to peripheral causes affecting semicircular canal function or central causes affecting the pons, medulla, or cerebellum. Arrhythmia is a recognized cause of dizziness in people with structural or ischemic heart disease. We report a case of exercise-induced transient ventricular tachycardia and dizziness in a man with no evidence of organic heart disease.
CASE SUMMARY A 42-year-old man presented with a 6 mo history of transient exercise-induced dizziness and prodromal palpitations. The patient was otherwise asymptomatic. Physical examination, otoscopy, vestibular tests, cerebellar tests, laboratory investigations, and imaging investigations were all unremarkable. Twenty-four hour Holter monitoring revealed four episodes of transient ventricular tachycardia during exercise. The patient was started on metoprolol and subsequently underwent radiofrequency catheter ablation. The patient reported a full recovery and no dizziness during daily activities. These results were maintained at the 6 mo follow-up.
CONCLUSION Ventricular tachycardia is an uncommon but potentially serious cause of dizziness. The outcome of this case illustrates the benefits of careful clinical examination and communication with specialized centers. High clinical suspicion of arrhythmia in a patient with dizziness merits consultation with a cardiologist and referral to a specialized center to ensure timely diagnosis and treatment.
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Affiliation(s)
- Li-Li Gao
- Department of Neurology, The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou 350003, Fujian Province, China
| | - Cheng-Han Wu
- Department of Neurology, The Second Affiliated Hospital of Fujian Traditional Chinese Medical University, Fuzhou 350003, Fujian Province, China
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24
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Martinez MW, Kim JH, Shah AB, Phelan D, Emery MS, Wasfy MM, Fernandez AB, Bunch TJ, Dean P, Danielian A, Krishnan S, Baggish AL, Eijsvogels TMH, Chung EH, Levine BD. Exercise-Induced Cardiovascular Adaptations and Approach to Exercise and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:1453-1470. [PMID: 34593128 DOI: 10.1016/j.jacc.2021.08.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022]
Abstract
The role of the sports cardiologist has evolved into an essential component of the medical care of athletes. In addition to the improvement in health outcomes caused by reductions in cardiovascular risk, exercise results in adaptations in cardiovascular structure and function, termed exercise-induced cardiac remodeling. As diagnostic modalities have evolved over the last century, we have learned much about the healthy athletic adaptation that occurs with exercise. Sports cardiologists care for those with known or previously unknown cardiovascular conditions, distinguish findings on testing as physiological adaptation or pathological changes, and provide evidence-based and "best judgment" assessment of the risks of sports participation. We review the effects of exercise on the heart, the approach to common clinical scenarios in sports cardiology, and the importance of a patient/athlete-centered, shared decision-making approach in the care provided to athletes.
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Affiliation(s)
- Matthew W Martinez
- Atlantic Health, Morristown Medical Center, Morristown, New Jersey, USA.
| | - Jonathan H Kim
- Emory School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia, USA
| | - Ankit B Shah
- Sports and Performance Cardiology Program, MedStar Health, Baltimore, Maryland, USA
| | - Dermot Phelan
- Sports Cardiology Center, Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Michael S Emery
- Sports Cardiology Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Meagan M Wasfy
- Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - Antonio B Fernandez
- Hartford HealthCare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut, USA
| | - T Jared Bunch
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Peter Dean
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Alfred Danielian
- Las Vegas Heart Associates-affiliated with Mountain View Hospital, Las Vegas, Nevada, USA
| | - Sheela Krishnan
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aaron L Baggish
- Massachusetts General Hospital Cardiovascular Performance Program, Boston, Massachusetts, USA
| | - Thijs M H Eijsvogels
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Physiology, Nijmegen, the Netherlands
| | - Eugene H Chung
- West MI Program, Cardiac EP Service, Sports Cardiology Clinic, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Dallas, and The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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25
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Katsi V, Soulaidopoulos S, Aggeli C, Latsios G, Tousoulis D, Toutouzas K, Tsioufis K. Extensive Coronary Artery Disease in a Long-Distance Athlete: A Case Report. J Athl Train 2021; 56:1137-1141. [PMID: 33351915 PMCID: PMC8530415 DOI: 10.4085/jat0330-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Despite the established benefits of regular physical activity in cardiovascular disease prevention, coronary events in the context of atherosclerotic coronary artery disease are the most common cause of exercise-related sudden death. A paradoxical development of an increased coronary calcification burden is likely associated with endurance training even in the absence of any of the traditional cardiovascular risk factors. In this case report, we present a 50-year-old male long-distance runner with excessive subclinical myocardial ischemia.
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Affiliation(s)
- Vasiliki Katsi
- First Department of Cardiology, Medical School of Athens, Hippokration Hospital, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, Medical School of Athens, Hippokration Hospital, Athens, Greece
| | - Constantina Aggeli
- First Department of Cardiology, Medical School of Athens, Hippokration Hospital, Athens, Greece
| | - George Latsios
- First Department of Cardiology, Medical School of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Medical School of Athens, Hippokration Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, Medical School of Athens, Hippokration Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School of Athens, Hippokration Hospital, Athens, Greece
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26
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Heidbuchel H. Push harder to allow pushing harder. Heart Rhythm 2021; 19:100-101. [PMID: 34563691 DOI: 10.1016/j.hrthm.2021.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Hein Heidbuchel
- Cardiovascular Research, Antwerp University, Antwerp, Belgium; Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium; Hasselt University, Hasselt, Belgium.
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27
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Pelliccia A, De Martino L, Borrazzo C, Serdoz A, Lemme E, Zorzi A, Corrado D. Clinical correlates and outcome of the patterns of premature ventricular beats in Olympic athletes: a long-term follow-up study. Eur J Prev Cardiol 2021; 28:1038-1047. [PMID: 32484042 DOI: 10.1177/2047487320928452] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/01/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The pattern of premature ventricular beats, as a clue to site of origin, may help identify underlying cardiac diseases. AIM To assess the value of premature ventricular beat patterns in managing athletes with ventricular arrhythmias. METHODS Athletes with 50 or more isolated premature ventricular beats/24 hours, and/or multifocal and/or repetitive premature ventricular beats at baseline, and/or exercise, and/or 24-hour electrocardiograms were selected for this analysis. Premature ventricular beats were defined as 'common' (outflow tract or fascicular origin), or 'uncommon' (other morphologies and/or multifocal or repetitive). RESULTS From 4595 athletes consecutively examined, 205 (4%, 24.6 ± 6.9 years, 67% men) were included, 118 (58%) with uncommon and 87 (42%) with common premature ventricular beats. In particular, 81 (39%) showed complex patterns; 63 (31%) right/left ventricular outflow tract origin; 24 (12%) fascicular origin; 20 (10%) right bundle branch block pattern, intermediate/superior axis, wide QRS; and 17 (8%) left bundle branch block pattern, intermediate/superior axis. Uncommon premature ventricular beat patterns were predominant among men (62% vs. 38%; P < 0.001) but not among women. Uncommon premature ventricular beats were equally prevalent in endurance, mixed and skill disciplines, but lower in power sports. Cardiac diseases were detected in 11 (5%), 10 with uncommon patterns. Over a 6-year follow-up, cardiac diseases occurred in four (0.6%/year), all with uncommon patterns. Overall, cardiac diseases at baseline and during follow-up were detected in 14/118 athletes with uncommon versus one/87 with common premature ventricular beats (P = 0.003). CONCLUSIONS Evaluation of premature ventricular beat patterns in Olympic athletes identified cardiac diseases, requiring disqualification and/or follow-up, in 12% with uncommon versus 1% with common patterns. This result suggests that athletes with uncommon premature ventricular beat patterns should undergo comprehensive cardiac evaluation and/or serial follow-up, irrespective of gender or sporting discipline.
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Affiliation(s)
- Antonio Pelliccia
- Department of Cardiology, Institute of Sport Medicine and Science, Italy
| | - Lorena De Martino
- Department of Cardiology, Institute of Sport Medicine and Science, Italy
| | - Cristian Borrazzo
- Department of Public Health and Infectious Disease, Sapienza University of Rome, Italy
| | - Andrea Serdoz
- Department of Cardiology, Institute of Sport Medicine and Science, Italy
| | - Erika Lemme
- Department of Cardiology, Institute of Sport Medicine and Science, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
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28
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Kasiakogias A, Papadakis M. Morphology of premature ventricular complexes: Time for a paradigm shift in the approach of ventricular ectopy in athletes? Eur J Prev Cardiol 2021; 28:1035-1037. [PMID: 32611249 DOI: 10.1177/2047487320937493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Michael Papadakis
- Cardiology Clinical and Academic Group, St George's, University of London, London, UK
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29
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Heidbuchel H, Arbelo E, D'Ascenzi F, Borjesson M, Boveda S, Castelletti S, Miljoen H, Mont L, Niebauer J, Papadakis M, Pelliccia A, Saenen J, Sanz de la Garza M, Schwartz PJ, Sharma S, Zeppenfeld K, Corrado D. Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part 2: ventricular arrhythmias, channelopathies, and implantable defibrillators. Europace 2021; 23:147-148. [PMID: 32596731 DOI: 10.1093/europace/euaa106] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This paper belongs to a series of recommendation documents for participation in leisure-time physical activity and competitive sports by the European Association of Preventive Cardiology (EAPC). Together with an accompanying paper on supraventricular arrhythmias, this second text deals specifically with those participants in whom some form of ventricular rhythm disorder is documented, who are diagnosed with an inherited arrhythmogenic condition, and/or who have an implanted pacemaker or cardioverter defibrillator. A companion text on recommendations in athletes with supraventricular arrhythmias is published in the European Journal of Preventive Cardiology. Since both texts focus on arrhythmias, they are the result of a collaboration between EAPC and the European Heart Rhythm Association (EHRA). The documents provide a framework for evaluating eligibility to perform sports, based on three elements, i.e. the prognostic risk of the arrhythmias when performing sports, the symptomatic impact of arrhythmias while performing sports, and the potential progression of underlying structural problems as the result of sports.
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Affiliation(s)
- Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, University Antwerp, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Mats Borjesson
- Centre for Health and Performance (CHP), Department of Food, Nutrition and Sport Sciences, Gothenburg University, Sweden.,Department of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden
| | - Serge Boveda
- Cardiology Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France
| | - Silvia Castelletti
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Laboratory of Cardiovascular Genetics, Milan, Italy
| | - Hielko Miljoen
- Department of Cardiology, University Hospital Antwerp, University Antwerp, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St. George's University of London, London, UK.,St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Antonio Pelliccia
- National Institute of Sports Medicine, Italian National Olympic Committee, Via dei Campi Sportivi 46, Rome, Italy
| | - Johan Saenen
- Department of Cardiology, University Hospital Antwerp, University Antwerp, Wilrijkstraat 10, 2650 Antwerp, Belgium
| | | | - Peter J Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Laboratory of Cardiovascular Genetics, Milan, Italy
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's University of London, London, UK.,St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Domenico Corrado
- Department of Cardiology, University of Padova, Padova, Italy.,Department of Pathology, University of Padova, Padova, Italy
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30
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Cardiac Biomarkers and Autoantibodies in Endurance Athletes: Potential Similarities with Arrhythmogenic Cardiomyopathy Pathogenic Mechanisms. Int J Mol Sci 2021; 22:ijms22126500. [PMID: 34204386 PMCID: PMC8235133 DOI: 10.3390/ijms22126500] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
The “Extreme Exercise Hypothesis” states that when individuals perform training beyond the ideal exercise dose, a decline in the beneficial effects of physical activity occurs. This is due to significant changes in myocardial structure and function, such as hemodynamic alterations, cardiac chamber enlargement and hypertrophy, myocardial inflammation, oxidative stress, fibrosis, and conduction changes. In addition, an increased amount of circulating biomarkers of exercise-induced damage has been reported. Although these changes are often reversible, long-lasting cardiac damage may develop after years of intense physical exercise. Since several features of the athlete’s heart overlap with arrhythmogenic cardiomyopathy (ACM), the syndrome of “exercise-induced ACM” has been postulated. Thus, the distinction between ACM and the athlete’s heart may be challenging. Recently, an autoimmune mechanism has been discovered in ACM patients linked to their characteristic junctional impairment. Since cardiac junctions are similarly impaired by intense physical activity due to the strong myocardial stretching, we propose in the present work the novel hypothesis of an autoimmune response in endurance athletes. This investigation may deepen the knowledge about the pathological remodeling and relative activated mechanisms induced by intense endurance exercise, potentially improving the early recognition of whom is actually at risk.
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Guía ESC 2020 sobre cardiología del deporte y el ejercicio en pacientes con enfermedad cardiovascular. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesselink JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021; 42:17-96. [PMID: 32860412 DOI: 10.1093/eurheartj/ehaa605] [Citation(s) in RCA: 751] [Impact Index Per Article: 250.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Volpato G, Falanga U, Cipolletta L, Conti MA, Grifoni G, Ciliberti G, Urbinati A, Barbarossa A, Stronati G, Fogante M, Bergonti M, Catto V, Guerra F, Giovagnoni A, Dello Russo A, Casella M, Compagnucci P. Sports Activity and Arrhythmic Risk in Cardiomyopathies and Channelopathies: A Critical Review of European Guidelines on Sports Cardiology in Patients with Cardiovascular Diseases. ACTA ACUST UNITED AC 2021; 57:medicina57040308. [PMID: 33805943 PMCID: PMC8064370 DOI: 10.3390/medicina57040308] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 12/27/2022]
Abstract
The prediction and prevention of sudden cardiac death is the philosopher’s stone of clinical cardiac electrophysiology. Sports can act as triggers of fatal arrhythmias and therefore it is essential to promptly frame the athlete at risk and to carefully evaluate the suitability for both competitive and recreational sports activity. A history of syncope or palpitations, the presence of premature ventricular complexes or more complex arrhythmias, a reduced left ventricular systolic function, or the presence of known or familiar heart disease should prompt a thorough evaluation with second level examinations. In this regard, cardiac magnetic resonance and electrophysiological study play important roles in the diagnostic work-up. The role of genetics is increasing both in cardiomyopathies and in channelopathies, and a careful evaluation must be focused on genotype positive/phenotype negative subjects. In addition to being a trigger for fatal arrhythmias in certain cardiomyopathies, sports also play a role in the progression of the disease itself, especially in the case arrhythmogenic right ventricular cardiomyopathy. In this paper, we review the latest European guidelines on sport cardiology in patients with cardiovascular diseases, focusing on arrhythmic risk stratification and the management of cardiomyopathies and channelopathies.
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Affiliation(s)
- Giovanni Volpato
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
- Correspondence:
| | - Umberto Falanga
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Laura Cipolletta
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Manuel Antonio Conti
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Gino Grifoni
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Giuseppe Ciliberti
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Alessia Urbinati
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Alessandro Barbarossa
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Giulia Stronati
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Marco Fogante
- Department of Radiology, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (M.F.); (A.G.)
| | - Marco Bergonti
- Department of Clinical Sciences and Community Health, University of Milan, 20100 Milan, Italy;
| | - Valentina Catto
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, 20100 Milan, Italy;
| | - Federico Guerra
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Andrea Giovagnoni
- Department of Radiology, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (M.F.); (A.G.)
| | - Antonio Dello Russo
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
| | - Michela Casella
- Department of Clinical, Special and Dental Sciences, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy;
| | - Paolo Compagnucci
- Department of Biomedical Science and Public Health, Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I-Lancisi-Salesi”, Marche Polytechnic University, 60100 Ancona, Italy; (U.F.); (L.C.); (M.A.C.); (G.G.); (G.C.); (A.U.); (A.B.); (G.S.); (F.G.); (A.D.R.); (P.C.)
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Pietrzak R, Książczyk TM, Górska E, Małek ŁA, Werner B. Evaluation of Galectin-3 Plasma Concentration in Adolescents with Ventricular Arrhythmia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052410. [PMID: 33801193 PMCID: PMC7967785 DOI: 10.3390/ijerph18052410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/21/2022]
Abstract
Galectin-3 (G3) is a biomarker known as an inflammatory state exponent. The aim of this paper was to analyze the G3 in adolescents with ventricular arrhythmia (VES) in order to evaluate its impact on myocardial tissue preservation. The study group (SG) consisted of 25 VES adolescents. The control group (CG) was 21 healthy children. G3 was assessed in the SG and CG. In the SG electrocardiography, Holter monitoring, echocardiography and CMR were performed. The G3 in SG was 13.45 ± 11.4 ng/mL and in CG 7.2 ± 2.0 ng/mL, p < 0.001. Moderate positive correlation between the G3 and z-score of the left ventricular diameter (r = 0.47, p = 0.041) and moderate negative correlation between the G3 and the left ventricular ejection fraction in cardiac magnetic resonance (CMR EF) (-0.49, p = 0.032) were found. According to the multiple linear regression analysis, CMR EF and VES were independent predictors for G3 elevation. Conclusion: Galectin-3 plasma concentration is elevated and correlates with the chosen left ventricular dysfunction parameters in adolescents suffering from ventricular arrhythmia. Further investigation is necessary to establish if elevated G3 is a useful biomarker for screening young individuals with ventricular arrhythmia who are at risk of structural cardiovascular pathology.
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Affiliation(s)
- Radosław Pietrzak
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Żwirki i Wigury Street 63a, 02-091 Warsaw, Poland; (T.M.K.); (B.W.)
- Correspondence:
| | - Tomasz M. Książczyk
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Żwirki i Wigury Street 63a, 02-091 Warsaw, Poland; (T.M.K.); (B.W.)
| | - Elżbieta Górska
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Żwirki i Wigury Street 63a, 02-091 Warsaw, Poland;
| | - Łukasz A. Małek
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, Alpejska Street 42, 04-628 Warsaw, Poland;
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Żwirki i Wigury Street 63a, 02-091 Warsaw, Poland; (T.M.K.); (B.W.)
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Tarantino N, Della Rocca DG, De Leon De La Cruz NS, Manheimer ED, Magnocavallo M, Lavalle C, Gianni C, Mohanty S, Trivedi C, Al-Ahmad A, Horton RP, Bassiouny M, Burkhardt JD, Gallinghouse GJ, Forleo GB, Di Biase L, Natale A. Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:205. [PMID: 33652714 PMCID: PMC7996951 DOI: 10.3390/medicina57030205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/22/2022]
Abstract
A recent surveillance analysis indicates that cardiac arrest/death occurs in ≈1:50,000 professional or semi-professional athletes, and the most common cause is attributable to life-threatening ventricular arrhythmias (VAs). It is critically important to diagnose any inherited/acquired cardiac disease, including coronary artery disease, since it frequently represents the arrhythmogenic substrate in a substantial part of the athletes presenting with major VAs. New insights indicate that athletes develop a specific electro-anatomical remodeling, with peculiar anatomic distribution and VAs patterns. However, because of the scarcity of clinical data concerning the natural history of VAs in sports performers, there are no dedicated recommendations for VA ablation. The treatment remains at the mercy of several individual factors, including the type of VA, the athlete's age, and the operator's expertise. With the present review, we aimed to illustrate the prevalence, electrocardiographic (ECG) features, and imaging correlations of the most common VAs in athletes, focusing on etiology, outcomes, and sports eligibility after catheter ablation.
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Affiliation(s)
- Nicola Tarantino
- Arrhythmia Service, Department of Medicine, Division of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA; (N.T.); (E.D.M.); (L.D.B.)
| | - Domenico G. Della Rocca
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | | | - Eric D. Manheimer
- Arrhythmia Service, Department of Medicine, Division of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA; (N.T.); (E.D.M.); (L.D.B.)
| | - Michele Magnocavallo
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy; (M.M.); (C.L.)
| | - Carlo Lavalle
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy; (M.M.); (C.L.)
| | - Carola Gianni
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | - Sanghamitra Mohanty
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | - Chintan Trivedi
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | - Amin Al-Ahmad
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | - Rodney P. Horton
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | - Mohamed Bassiouny
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | - J. David Burkhardt
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | - G. Joseph Gallinghouse
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
| | - Giovanni B. Forleo
- Department of Cardiology, Azienda Ospedaliera-Universitaria “Luigi Sacco”, 20057 Milano, Italy;
| | - Luigi Di Biase
- Arrhythmia Service, Department of Medicine, Division of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA; (N.T.); (E.D.M.); (L.D.B.)
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Andrea Natale
- St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA; (S.M.); (C.T.); (A.A.-A.); (R.P.H.); (M.B.); (J.D.B.); (G.J.G.); (A.N.)
- Interventional Electrophysiology, Scripps Clinic, La Jolla, CA 92037, USA
- Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
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Narducci ML, Cammarano M, Novelli V, Bisignani A, Pavone C, Perna F, Bencardino G, Pinnacchio G, Bianco M, Zeppilli P, Palmieri V, Pelargonio G. Diagnostic Workflow in Competitive Athletes with Ventricular Arrhythmias and Suspected Concealed Cardiomyopathies. Medicina (B Aires) 2021; 57:medicina57020182. [PMID: 33672601 PMCID: PMC7924041 DOI: 10.3390/medicina57020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 11/16/2022] Open
Abstract
The diagnosis of structural heart disease in athletes with ventricular arrhythmias (VAs) and an apparently normal heart can be very challenging. Several pieces of evidence demonstrate the importance of an extensive diagnostic work-up in apparently healthy young patients for the characterization of concealed cardiomyopathies. This study shows the various diagnostic levels and tools to help identify which athletes need deeper investigation in order to unmask possible underlying heart disease.
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Affiliation(s)
- Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (G.B.); (G.P.); (G.P.)
- Correspondence:
| | - Michela Cammarano
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (M.B.); (P.Z.); (V.P.)
| | - Valeria Novelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Genetica Medica, 00168 Rome, Italy;
- Istituto di Medicina Genomica, Università del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Antonio Bisignani
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (A.B.); (C.P.)
| | - Chiara Pavone
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (A.B.); (C.P.)
| | - Francesco Perna
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (G.B.); (G.P.); (G.P.)
| | - Gianluigi Bencardino
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (G.B.); (G.P.); (G.P.)
| | - Gaetano Pinnacchio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (G.B.); (G.P.); (G.P.)
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (A.B.); (C.P.)
| | - Massimiliano Bianco
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (M.B.); (P.Z.); (V.P.)
| | - Paolo Zeppilli
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (M.B.); (P.Z.); (V.P.)
| | - Vincenzo Palmieri
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (M.B.); (P.Z.); (V.P.)
| | - Gemma Pelargonio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (G.B.); (G.P.); (G.P.)
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (A.B.); (C.P.)
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Important tips reflected in our daily practice from the American College of Cardiology Electrophysiology Council report on premature ventricular contractions. Anatol J Cardiol 2021; 23:196-203. [PMID: 32235139 PMCID: PMC7163219 DOI: 10.14744/anatoljcardiol.2020.91572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Premature ventricular contractions (PVCs) is one of the most common situations in the current cardiology practice. Although PVCs are generally benign in people without any structural heart disease, they may be associated with left ventricular dysfunction, cardiomyopathy, and, rarely, sudden death. Recently, there has been a considerable research in the pathophysiology of PVC, several clinical presentations in different situations, new proposals of successful diagnostic methods, and treatment modalities. Finally, the American College of Cardiology Electrophysiology Council has published a special report that deals with all the aspects of PVC. We reviewed the important points from this report that can be reflected in our daily practice.
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Di Florio A, Fusi C, Anselmi F, Cavigli L, Focardi M, Cameli M, Felici A, Capitani M, Valente S, Bonifazi M, Zorzi A, Corrado D, Mondillo S, D'Ascenzi F. Clinical management of young competitive athletes with premature ventricular beats: A prospective cohort study. Int J Cardiol 2021; 330:59-64. [PMID: 33582199 DOI: 10.1016/j.ijcard.2021.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/25/2021] [Accepted: 02/08/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Premature ventricular beats (PVBs) are not an unusual finding and their interpretation is sometimes challenging. Unfortunately, few data on the characteristics of PVBs that correlate with the risk of an underlying heart disease are available in athletes. OBJECTIVES The aim of this prospective study was to investigate the diagnostic and prognostic value of PVBs characteristics in competitive athletes. METHODS From a cohort of 1751 athletes evaluated at our sports cardiology centre, we enrolled 112 competitive athletes <40 years of age (mean age 21 ± 10 years) and with no known heart disease referred for PVBs. All athletes underwent physical examination, ECG, 12‑lead ambulatory ECG monitoring, exercise testing, and echocardiography. Further investigations including cardiac magnetic resonance were performed for abnormal findings at first-line evaluation or for specific PVBs characteristics. RESULTS The majority (79%) of athletes exhibited monomorphic PVBs with a fascicular or infundibular pattern (common morphologies). A definitive diagnosis of cardiac disease was reached in 26 athletes (23% of the entire population) and correlated with uncommon PVBs morphology (p < 0.001) and arrhythmia complexity (p < 0.001). The number of PVBs/24-h was lower in athletes with cardiac disease than in those with normal heart (p < 0.05). During the follow-up a spontaneous reduction of PVBs and no adverse events were observed. CONCLUSIONS Infundibular and fascicular PVBs were the most common morphologies observed in athletes with ventricular arrhythmias referred for cardiological evaluation. Morphology and complexity of PVBs, but not their number, predicted the probability of an underlying disease. Athletes with PVBs and negative investigation showed a good prognosis.
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Affiliation(s)
- Alex Di Florio
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Chiara Fusi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Francesca Anselmi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Andrea Felici
- Sports Medicine Centre, Colle di Val d'Elsa, Siena, Italy
| | - Massimo Capitani
- Centre for Sports Medicine, National Health Service, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Marco Bonifazi
- Department of Medicine, Surgery, and NeuroScience, University of Siena, Siena, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy.
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39
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Tiller NB, Stewart GM, Illidi CR, Levine BD. Exercise Is Medicine? The Cardiorespiratory Implications of Ultra-marathon. Curr Sports Med Rep 2021; 19:290-297. [PMID: 32769665 DOI: 10.1249/jsr.0000000000000738] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Regular physical activity decreases the risk of cardiovascular disease, type II diabetes, obesity, certain cancers, and all-cause mortality. Nevertheless, there is mounting evidence that extreme exercise behaviors may be detrimental to human health. This review collates several decades of literature on the physiology and pathophysiology of ultra-marathon running, with emphasis on the cardiorespiratory implications. Herein, we discuss the prevalence and clinical significance of postrace decreases in lung function and diffusing capacity, respiratory muscle fatigue, pulmonary edema, biomarkers of cardiac injury, left/right ventricular dysfunction, and chronic myocardial remodeling. The aim of this article is to inform risk stratification for ultra-marathon and to edify best practice for personnel overseeing the events (i.e., race directors and medics).
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Affiliation(s)
- Nicholas B Tiller
- Institute of Respiratory Medicine and Exercise Physiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA
| | - Glenn M Stewart
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Camilla R Illidi
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, UNITED KINGDOM
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, TX
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Sanchis-Gomar F, Lavie CJ, Perez MV. Consumer wearable technologies to identify and monitor exercise-related arrhythmias in athletes. Curr Opin Cardiol 2021; 36:10-16. [PMID: 33074935 DOI: 10.1097/hco.0000000000000817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to synthesize the current evidence supporting and against the use of wearable devices to detect underlying heart conditions in athletes and the most significant limitations. RECENT FINDINGS Although several large studies have been conducted to evaluate the ability of wearables devices to identify atrial fibrillation among the general population, no studies evaluating their ability to detect other exercise-related arrhythmias in athletes are very sparse. Most of the studies or case reports are focused on the wearables' reliability and accuracy compared with standard ECG. Only small studies evaluating the accuracy of one wearable device in athletes have been carried out to date. Unfortunately, none of them have investigated their ability to detect specific arrhythmias in the athletic population. SUMMARY Rapidly detecting dangerous arrhythmias in a symptomatic athlete continues to be an elusive goal. The use of smartphone ECG monitors can provide diagnostic data in athletes with symptoms that could represent a helpful instrument. However, many uncertainties remain and need to be addressed and validated in large-scale trials to incorporate these devices into the healthcare system and be part of an athlete's daily monitoring and healthcare.
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Affiliation(s)
- Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, Louisiana, USA
| | - Marco V Perez
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
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41
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Ollitrault P, Pellissier A, Reboursière E, Milliez P, Hodzic A. The “V1 continuum” on the surface ECG of apparently healthy athletes. Scand J Med Sci Sports 2020; 30:2275-2276. [DOI: 10.1111/sms.13801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Pierre Ollitrault
- Department of Cardiology Caen University Hospital Normandie Univ UniCaen Caen France
| | - Arnaud Pellissier
- Department of Cardiology Caen University Hospital Normandie Univ UniCaen Caen France
| | - Emmanuel Reboursière
- Clinical Physiology and Sports Medecine Department Caen University Hospital Normandie Univ UniCaen INSERM COMETE Caen France
| | - Paul Milliez
- Department of Cardiology Caen University Hospital Normandie Univ UniCaen Caen France
| | - Amir Hodzic
- Clinical Physiology and Sports Medecine Department Caen University Hospital Normandie Univ UniCaen INSERM COMETE Caen France
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42
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Abela M, Sharma S. Electrocardiographic interpretation in athletes. Minerva Cardiol Angiol 2020; 69:533-556. [PMID: 33059398 DOI: 10.23736/s2724-5683.20.05331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Participation in regular exercise of moderate intensity is associated with a plethora of systemic benefits, including a reduction in risk factors for coronary atherosclerosis; however, intensive exercise may paradoxically culminate in sudden cardiac arrest among individuals harboring arrhythmogenic substrates. The precise mechanism for arrhythmogenesis is likely multifactorial, however, surges in catecholamines, electrolyte shifts, acid-base disturbances, increased core temperature and demand myocardial ischemia are potential contributors. Although most deaths occur in middle aged and older males with atherosclerotic coronary artery disease, a significant proportion also affect young athletes with inherited or congenital cardiac abnormalities. The impact of such catastrophes on society, particularly when a young high-profile athlete is affected could be considered a justified reason for identifying individuals who may be at risk. Given the rarity of deaths in young athletes, only the simplest screening test, such as the 12-lead electrocardiography (ECG) may be considered to be cost effective. The ECG is effective for detecting serious electrical diseases in young athletes such as congenital electrical accessory pathways and ion channel diseases but can also identify athletes with potential life-threatening structural diseases such as hypertrophic and arrhythmogenic cardiomyopathy. One of the concerns about ECG screening is that regular intensive exercise results in several physiological alterations in cardiac structure and function that are reflected on the athlete's ECG. Sinus bradycardia, first-degree atrioventricular block, incomplete right bundle branch block, minor J-point elevation and large QRS voltages are common. Conversely, some repolarization anomalies affecting the ST segment, T waves and QT interval may overlap with patterns observed in patients with serious cardiac diseases. The situation is complicated further because age, sex and ethnicity of the athletes also influence the ECG and there is a risk that erroneous interpretation could have serious consequences. This review will describe the normal electrical patterns of the "athlete's heart" and provide insights into differentiation physiological electrical patterns from those observed in serious cardiac disease.
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Affiliation(s)
- Mark Abela
- Department of Cardiology, Mater Dei Hospital, Msida, Malta - .,Malta Medical School, University of Malta, Msida, Malta - .,St. George's University Hospitals, NHS Foundation Trust, St George's University, London, UK -
| | - Sanjay Sharma
- St. George's University Hospitals, NHS Foundation Trust, St George's University, London, UK
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43
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(Sports and cardiac arrhythmias). COR ET VASA 2020. [DOI: 10.33678/cor.2020.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Zorzi A, Vio R, Bettella N, Corrado D. Criteria for interpretation of the athlete's ECG: A critical appraisal. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:882-890. [PMID: 32602144 DOI: 10.1111/pace.14001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/18/2020] [Accepted: 06/28/2020] [Indexed: 01/27/2023]
Abstract
The electrocardiogram (ECG) is cheap and widely available but its use as a screening tool for early identification of athletes with a cardiac disease at risk of sudden cardiac death is controversial because of presumed low specificity. In the last decade, several efforts have been made to improve the distinction between physiological and pathological ECG findings in the athlete, leading to continuous evolution of the interpretation criteria. The most recent 2017 International criteria grouped ECG changes into three categories: normal, borderline, and abnormal. Borderline findings warrant further investigations only when two or more are present while abnormal changes should always be considered as the sign of a possible underlying disease. This review encompasses the evolution of the athlete's ECG interpretation criteria and highlights areas of uncertainty that will need to be addressed by further studies.
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Affiliation(s)
- Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Riccardo Vio
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Natascia Bettella
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Crescenzi C, Panattoni G, Stazi A, Martino A, Sgueglia M, De Ruvo E, Calò L. Ventricular arrhythmias and risk stratification of cardiac sudden death in athletes. Minerva Cardioangiol 2020; 68:110-122. [PMID: 32429629 DOI: 10.23736/s0026-4725.20.05178-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sudden cardiac death (SCD) of young athletes is an unexpected and tragic event that could occur during sport activities and is frequently related to ventricular arrhythmias. Identifying athletes at risk of SCD remains a major challenge. While specific characteristics of premature ventricular contractions are considered common and benign, other "uncommon" features should require more accurate investigations, in order to determine eligibility for competitive sports. The most common type of idiopathic premature ventricular contractions originates from ventricular outflow tract and is characterized by an ECG pattern with left bundle branch block and inferior QRS axis (infundibular pattern). Another pattern associated with a good prognosis is the "fascicular" morphology, characterized by a typical right bundle branch block, superior QRS axis morphology and QRS duration <130 ms. Conversely, other morphological features (such as left bundle branch block /intermediate or superior axis or right bundle branch block/intermediate or superior axis and wide QRS) correlate to an underlying substrate. In risk stratification setting, cardiac magnetic resonance plays a key role allowing an accurate identification of myocardial tissue abnormalities, which could affect athletes' prognosis. This review focuses on characteristics of premature ventricular contractions characteristics in terms of morphology, distribution, complexity and response to exercise and describes the possible underlying myocardial substrates. This review also critically analyzes the evaluation process of athletes with premature ventricular contractions necessary for an accurate risk stratification.
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Affiliation(s)
| | | | | | | | | | | | - Leonardo Calò
- Division of Cardiology, Casilino Polyclinic, Rome, Italy -
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Sanz-de la Garza M, Carro A, Caselli S. How to interpret right ventricular remodeling in athletes. Clin Cardiol 2020; 43:843-851. [PMID: 32128858 PMCID: PMC7403694 DOI: 10.1002/clc.23350] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/08/2019] [Accepted: 02/17/2020] [Indexed: 12/21/2022] Open
Abstract
Long-lasting athletic training induces an overload on the heart that leads to structural, functional, and electrical adaptive changes known as the "athlete's heart." The amount of this heart remodeling has been traditionally considered balanced between the left and the right heart chambers. However, during intense exercise, the right heart is exposed to a disproportional afterload and wall stress which over a long period of time could lead to more pronounced exercise-induced changes. Highly trained athletes, especially those involved in endurance sport disciplines, can develop marked right ventricular (RV) remodeling that could raise the suspicion of an underlying RV pathology including arrhythmogenic cardiomyopathy (ACM). The distinction between physiological and pathological RV remodeling is essential as ACM is a common cause of sudden cardiac death in athletes, and high-intensity exercise training has demonstrated to accelerate its phenotypic expression and worsen its prognosis. The distinction between physiological and pathological RV remodeling is essential since ACM is a common cause of sudden cardiac death in athletes, and high-intensity exercise training has demonstrated to accelerate the phenotypic expression and worsen the prognosis. This article outlines the physiological adaptation of the RV to acute exercise, the subsequent physiological structural and functional changes induced by athletic training and provides useful tips of how to differentiate between physiological RV remodeling and a cardiomyopathy phenotype.
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Affiliation(s)
| | | | - Stefano Caselli
- Cardiovascular Center Zürich, Klinik im Park, Zürich, Switzerland
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47
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Ollitrault P, Pellissier A, Champ-Rigot L, Junqua N, Chequel M, Reboursiere E, Saloux É, Milliez P, Hodzic A. Prevalence and significance of fragmented QRS complex in lead V1 on the surface electrocardiogram of healthy athletes. Europace 2020; 22:649-656. [DOI: 10.1093/europace/euaa037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/29/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Limited data exist concerning fragmented QRS complexes (fQRSs) on the surface electrocardiogram (ECG) of apparently healthy athletes. We aimed to study the prevalence and significance of fQRS in lead V1 (fQRSV1), representing right ventricular (RV) activation, regarding training-induced RV morphological remodelling.
Methods and results
Between January 2017 and August 2019, 434 consecutive non-sedentary subjects underwent preparticipation cardiovascular screening, including a 12-lead ECG. Three hundred and ninety-three apparently healthy subjects were included, 119 of them were athletes (defined as performing ≥8 h/week for the last 6 months) and 274 were non-athletes. All athletes underwent two-dimensional transthoracic echocardiography. Fragmented QRS complex in lead V1 pattern was defined as a narrow (<120 ms) and quadriphasic QRS complex in lead V1. Fragmented QRS complex in lead V1 was more frequent in athletes compared with non-athletes (22% vs. 5.1%, P < 0.001) and was independently associated with the athlete status [adjusted odds ratio (aOR) = 4.693, 95% confidence interval (95% CI) 2.299—9.583; P < 0.001], the endurance category (aOR = 2.522, 95% CI 1.176—5.408; P = 0.017), and age (aOR = 0.962, 95% CI 0.934–0.989; P = 0.007) in multivariate analysis. In the subgroup of athletes, fQRSV1 was independently associated with mean RV outflow tract diameter (aOR = 1.458, 95% CI 1.105–1.923; P = 0.008) and age (aOR = 0.941, 95% CI 0.894–0.989; P = 0.017) in multivariate analysis.
Conclusion
Fragmented QRS complex in lead V1 is a newly described, frequent, ECG pattern in young and apparently healthy athletes and is associated with training-induced RV remodelling.
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Affiliation(s)
- Pierre Ollitrault
- Department of Cardiology, Caen University Hospital, Avenue de la Côte de Nacre, F-14000 Caen, France
- Department of Clinical, Physiology and Sports Medicine, Caen University Hospital, Avenue de la Côte de Nacre, F-14000 Caen, France
- Normandie University, UniCaen, INSERM COMETE, Rue des Rochambelles, F-14000 Caen, France
| | - Arnaud Pellissier
- Department of Cardiology, Caen University Hospital, Avenue de la Côte de Nacre, F-14000 Caen, France
| | - Laure Champ-Rigot
- Department of Cardiology, Caen University Hospital, Avenue de la Côte de Nacre, F-14000 Caen, France
- Normandie University, UniCaen, INSERM COMETE, Rue des Rochambelles, F-14000 Caen, France
| | - Nicolas Junqua
- Department of Cardiology, Caen University Hospital, Avenue de la Côte de Nacre, F-14000 Caen, France
| | - Mathieu Chequel
- Department of Cardiology, Caen University Hospital, Avenue de la Côte de Nacre, F-14000 Caen, France
- Normandie University, UniCaen, INSERM COMETE, Rue des Rochambelles, F-14000 Caen, France
| | - Emmanuel Reboursiere
- Department of Clinical, Physiology and Sports Medicine, Caen University Hospital, Avenue de la Côte de Nacre, F-14000 Caen, France
| | - Éric Saloux
- Department of Cardiology, Caen University Hospital, Avenue de la Côte de Nacre, F-14000 Caen, France
- Normandie University, UniCaen, INSERM COMETE, Rue des Rochambelles, F-14000 Caen, France
| | - Paul Milliez
- Department of Cardiology, Caen University Hospital, Avenue de la Côte de Nacre, F-14000 Caen, France
- Normandie University, UniCaen, INSERM COMETE, Rue des Rochambelles, F-14000 Caen, France
| | - Amir Hodzic
- Department of Cardiology, Caen University Hospital, Avenue de la Côte de Nacre, F-14000 Caen, France
- Department of Clinical, Physiology and Sports Medicine, Caen University Hospital, Avenue de la Côte de Nacre, F-14000 Caen, France
- Normandie University, UniCaen, INSERM COMETE, Rue des Rochambelles, F-14000 Caen, France
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48
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Routine Use of Cardiovascular Magnetic Resonance in the Work-Up of Patients With Ventricular Arrhythmias? JACC Cardiovasc Imaging 2020; 13:422-424. [PMID: 31954638 DOI: 10.1016/j.jcmg.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 11/23/2022]
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49
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Porcedda G, Brambilla A, Favilli S, Spaziani G, Mascia G, Giaccardi M. Frequent Ventricular Premature Beats in Children and Adolescents: Natural History and Relationship with Sport Activity in a Long-Term Follow-Up. Pediatr Cardiol 2020; 41:123-128. [PMID: 31712859 DOI: 10.1007/s00246-019-02233-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/25/2019] [Indexed: 02/07/2023]
Abstract
Premature ventricular complexes (PVCs) are frequently documented in children. To date, few studies report long-term follow-up in pediatric cohorts presenting with frequent PVCs. The aim of this study is to assess the clinical relevance and long-term outcomes of frequent PVCs (≥ 500/24 h) in a large pediatric cohort. From 1996 to 2016, we enrolled all consecutive patients evaluated at Anna Meyer Children Hospital for frequent PVCs. Symptomatic children were excluded together with those patients with known underlying heart diseases; thus, our final cohort of study included 103 patients (male 66%; mean age 11 ± 3.4 years), with a mean follow-up of 9.5 ± 5.5 years. All patients were submitted to complete non-invasive cardiologic evaluation. The mean number of PVCs at Holter Monitoring (HM) was 11,479 ± 13,147/24 h; couplets and/or triplets were observed in 5/103 (4.8%) cases; 3 patients (2.9%) presented runs of non-sustained ventricular tachycardia (NSVT). High-burden PVCs (> 30,000/24 h) was confirmed in 11/103 (10.6%) patients. During the follow-up, only five patients (4.8%) developed clinical symptoms (3 for palpitations, 1 myocardial dysfunction due to frequent PVCs and NTSV; 1 arrhythmogenic cardiomyopathy); no deaths occurred. Basal PVCs were still present in 45/103 (43.7%) patients. Our data suggest that frequent PVCs may be addressed as a benign condition and should not preclude sport participation if not associated with cardiac malformations, heart dysfunction, or cardiomyopathy. This seems to be true also in presence of very frequent/high-burden PVCs. Otherwise, a careful follow-up is mandatory since sport eligibility should be reconsidered in case of onset of symptoms and/or ECG/echocardiographic changes.
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Affiliation(s)
- Giulio Porcedda
- Pediatric Cardiology Unit, A. Meyer Hospital, Viale Pieraccini 24, 50139, Florence, Italy.
| | - Alice Brambilla
- Pediatric Cardiology Unit, A. Meyer Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Silvia Favilli
- Pediatric Cardiology Unit, A. Meyer Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Gaia Spaziani
- Pediatric Cardiology Unit, A. Meyer Hospital, Viale Pieraccini 24, 50139, Florence, Italy
| | - Giuseppe Mascia
- Cardiology and Electrophysiology Unit, S. M. Nuova Hospital, Florence, Italy
| | - Marzia Giaccardi
- Cardiology and Electrophysiology Unit, S. M. Nuova Hospital, Florence, Italy
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50
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Abela M, Sharma S. Abnormal ECG Findings in Athletes: Clinical Evaluation and Considerations. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:95. [PMID: 31865466 DOI: 10.1007/s11936-019-0794-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Pre-participation cardiovascular evaluation with electrocardiography is normal practice for most sporting bodies. Awareness about sudden cardiac death in athletes and recognizing how screening can help identify vulnerable athletes have empowered different sporting disciplines to invest in the wellbeing of their athletes. RECENT FINDINGS Discerning physiological electrical alterations due to athletic training from those representing cardiac pathology may be challenging. The mode of investigation of affected athletes is dependent on the electrical anomaly and the disease(s) in question. This review will highlight specific pathological ECG patterns that warrant assessment and surveillance, together with an in-depth review of the recommended algorithm for evaluation.
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Affiliation(s)
- Mark Abela
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK.
- University of Malta, Msida, Malta.
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
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