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Mahendran S, Gupta I, Davis J, Davis AJ, Orchard JW, Orchard JJ. Comparison of methods for correcting QT interval in athletes and young people: A systematic review. Clin Cardiol 2023; 46:1106-1115. [PMID: 37470093 PMCID: PMC10540007 DOI: 10.1002/clc.24093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/18/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023] Open
Abstract
Screening elite athletes for conditions associated with sudden cardiac death is recommended by numerous international guidelines. Current athlete electrocardiogram interpretation criteria recommend the Bazett formula (QTcB) for correcting QT interval. However, other formulae may perform better at lower and higher heart rates (HR). This review aimed to examine the literature on various QT correction methods in athletes and young people aged 14-35 years and determine the most accurate method of calculating QTc in this population. A systematic review of MEDLINE, EMBASE, Scopus, and SportDiscus was performed. Papers comparing at least two different methods of QT interval correction in athletes or young people were included. Quality and risk of bias were assessed using a standardized tool. The search strategy identified 545 papers, of which 10 met the criteria and were included. Nine of these studies concluded that QTcB was least reliable for removing the effect of HR and was inaccurate at both high (>90 beats per min [BPM]) and low (<60 BPM) HRs. No studies supported the use of QTcB in athletes and young people. Alternative QT correction algorithms such as Fridericia (QTcF) produce more accurate correction of QT interval at HRs seen in athletes and young people. QTcB is less accurate at lower and higher HRs. QTcF has been shown to be more accurate in these HR ranges and may be preferred to QTcB for QTc calculation in athletes and young people. However, accurate QTc reference values for discrete HRs using alternative algorithms are not well established and require further research.
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Affiliation(s)
- Shehane Mahendran
- Sydney School of Public HealthThe University of SydneySydneyAustralia
| | - Ishita Gupta
- Sydney School of Public HealthThe University of SydneySydneyAustralia
| | - Jason Davis
- Sydney School of Public HealthThe University of SydneySydneyAustralia
- Royal Brisbane and Women's HospitalBrisbaneAustralia
- School of MedicineUniversity of QueenslandBrisbaneAustralia
| | - Angus J. Davis
- Sydney School of Public HealthThe University of SydneySydneyAustralia
| | - John W. Orchard
- Sydney School of Public HealthThe University of SydneySydneyAustralia
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2
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Torstveit MK, Ackerman KE, Constantini N, Holtzman B, Koehler K, Mountjoy ML, Sundgot-Borgen J, Melin A. Primary, secondary and tertiary prevention of Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the IOC consensus on REDs. Br J Sports Med 2023; 57:1119-1126. [PMID: 37752004 DOI: 10.1136/bjsports-2023-106932] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/28/2023]
Abstract
Relative Energy Deficiency in Sport (REDs) is common among female and male athletes representing various sports at different performance levels, and the underlying cause is problematic low energy availability (LEA). It is essential to prevent problematic LEA to decrease the risk of serious health and performance consequences. This narrative review addresses REDs primary, secondary and tertiary prevention strategies and recommends best practice prevention guidelines targeting the athlete health and performance team, athlete entourage (eg, coaches, parents, managers) and sport organisations. Primary prevention of REDs seeks to minimise exposure to and reduce behaviours associated with problematic LEA. Some of the important strategies are educational initiatives and de-emphasising body weight and leanness, particularly in young and subelite athletes. Secondary prevention encourages the early identification and management of REDs signs or symptoms to facilitate early treatment to prevent development of more serious REDs outcomes. Recommended strategies for identifying athletes at risk are self-reported screening instruments, individual health interviews and/or objective assessment of REDs markers. Tertiary prevention (clinical treatment) seeks to limit short-term and long-term severe health consequences of REDs. The cornerstone of tertiary prevention is identifying the source of and treating problematic LEA. Best practice guidelines to prevent REDs and related consequences include a multipronged approach targeting the athlete health and performance team, the athlete entourage and sport organisations, who all need to ensure a supportive and safe sporting environment, have sufficient REDs knowledge and remain observant for the early signs and symptoms of REDs.
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Affiliation(s)
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Naama Constantini
- Sport Medicine, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Bryan Holtzman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karsten Koehler
- Department of Sport and Health Sciences, Technical University of Munich, München, Germany
| | - Margo L Mountjoy
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Anna Melin
- Department of Sport Science, Linnaeus University, Vaxjo/Kalmar, Sweden
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Ben Abdessalem MA, Ghariani A, Fekih Romdhane A, Ben Ameur Z, Bouraoui H, Abdelah M, Ernez-Hajri S. [Monocentric retrospective study on the prevalence and significance of incomplete right bundle branch block in young competitive athletes in Tunisia]. Ann Cardiol Angeiol (Paris) 2023; 72:101582. [PMID: 36934479 DOI: 10.1016/j.ancard.2023.02.003] [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: 11/16/2022] [Revised: 12/17/2022] [Accepted: 02/13/2023] [Indexed: 03/19/2023]
Abstract
AIMS Few studies have assessed the prevalence and significance of right bundle branch block in athletes. Aims of this study were to evaluate the prevalence of incomplete right bundle branch block and its correlation with the nature of sports practice and to compare the athlete with right bundle branch block and the one with a normal electrocardiogram. METHODS It was a retrospective study of the electrocardiogram and echocardiography of competitive athletes recruited in the medical-sports center of Sousse RESULTS: A total of 554 athletes were included. Mean age was 16.1 ± 2.9 years and 69 % were male. The mean training duration was 5.8 hours per week. The prevalence of incomplete right bundle branch block was 13.9 % (77 cases). Endurance sports were practiced in 71.4 % of cases among subjects with right bundle branch block versus 55.4 % in the rest of the population (p < 0.001). The basal diameter of the right ventricle was larger in athletes with right bundle branch block compared to athletes without right bundle branch block: 28 ± 3.6 mm versus 24 ± 2.4 mm (p < 0.001). CONCLUSIONS The results of this study suggest that right bundle branch block is a marker of incomplete right ventricular remodeling. This remodeling represents a form of adaptation to sustained elevation of volumetric load observed mainly in endurance sports.
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Affiliation(s)
| | - Anis Ghariani
- Service de cardiologie, Centre hospital-universitaire Farhat Hached, Sousse, Tunisie.
| | - Ahmed Fekih Romdhane
- Service de cardiologie, Centre hospital-universitaire Farhat Hached, Sousse, Tunisie
| | - Zied Ben Ameur
- Service de cardiologie, Centre hospital-universitaire Farhat Hached, Sousse, Tunisie
| | - Hatem Bouraoui
- Service de cardiologie, Centre hospital-universitaire Farhat Hached, Sousse, Tunisie
| | - Mahdhaoui Abdelah
- Service de cardiologie, Centre hospital-universitaire Farhat Hached, Sousse, Tunisie; Université de Sousse, Laboratoire de recherche : LR14ES05 : Interaction du système cardio-pulmonaire, Faculté de Médecine de Sousse, Tunisie
| | - Samia Ernez-Hajri
- Service de cardiologie, Centre hospital-universitaire Farhat Hached, Sousse, Tunisie; Hôpital Farhat Hached de Sousse, Laboratoire de recherche : LRSP09 : Insuffisance cardiaque, Tunisie
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Ma Y, Qi M, Li K, Wang Y, Ren F, Gao D. Conventional and genetic associations between resting heart rate, cardiac morphology and function as assessed by magnetic resonance imaging: Insights from the UK biobank population study. Front Cardiovasc Med 2023; 10:1110231. [PMID: 37008308 PMCID: PMC10063878 DOI: 10.3389/fcvm.2023.1110231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/28/2023] [Indexed: 03/19/2023] Open
Abstract
AimTo examine the direction, strength and causality of the associations of resting heart rate (RHR) with cardiac morphology and function in 20,062 UK Biobank participants.Methods and resultsParticipants underwent cardiac magnetic resonance (CMR) and we extracted CMR biventricular structural and functional metrics using automated pipelines. Multivariate linear regression adjusted for the main cardiovascular risk factors and Two-sample Mendelian Randomization analyses were performed to assess the potential relationship, grouped by heart rate and stratified by sex. Each 10 beats per minute increase in RHR was linked with smaller ventricular structure (lower biventricular end-diastolic volume and end-systolic volume), poorer left ventricular (LV) function (lower LV ejection fraction, global longitude strain and global function index) and unhealthy pattern of LV remodeling (higher values of myocardial contraction fraction), but there is no statistical difference in LV wall thickness. These trends are more pronounced among males and consistent with the causal effect direction of genetic variants interpretation. These observations reflect that RHR has an independent and broad impact on LV remodeling, however, genetically-predicted RHR is not statistically related to heart failure.ConclusionWe demonstrate higher RHR cause smaller ventricular chamber volume, poorer systolic function and unhealthy cardiac remodeling pattern. Our findings provide effective evidence for the potential mechanism of cardiac remodeling and help to explore the potential scope or benefit of intervention.
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Affiliation(s)
- Yao Ma
- Cardiology Diseases Department, Xi’an Jiaotong University Second Affiliated Hospital, Xi’an, China
| | - Mengyao Qi
- Cardiology Diseases Department, Xi’an Jiaotong University Second Affiliated Hospital, Xi’an, China
| | - Kexin Li
- Cardiology Diseases Department, Xi’an Jiaotong University Second Affiliated Hospital, Xi’an, China
| | - Yuan Wang
- Cardiology Diseases Department, Xi’an Jiaotong University Second Affiliated Hospital, Xi’an, China
| | - Fuxian Ren
- Department of Cardiology, Meishan Brach of the Third Affiliated Hospital, Yanan University School of Medical, Meishan, China
- Correspondence: Dengfeng Gao Fuxian Ren
| | - Dengfeng Gao
- Cardiology Diseases Department, Xi’an Jiaotong University Second Affiliated Hospital, Xi’an, China
- Correspondence: Dengfeng Gao Fuxian Ren
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Aymen Mohamed BA, Anis G, Ahmed FR, Zied BA, Hatem B, Mahdhaoui A, Samia EH. [Correlation between changes in electrocardiographic and echocardiographic measurements and the nature of the sport practiced]. Ann Cardiol Angeiol (Paris) 2023; 72:101580. [PMID: 36872127 DOI: 10.1016/j.ancard.2023.02.001] [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: 11/16/2022] [Revised: 12/01/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023]
Abstract
AIMS Intense and regular sports practice leads to electrical and morphological cardiac remodeling. The aim of this study was to investigate a correlation between electrocardiographic and echocardiographic changes and the nature of the sport practiced. METHODS Retrospective study of the electrocardiogram and echocardiography of competitive athletes recruited in the medical-sports center of Sousse RESULTS: A total of 554 athletes were included. The mean age was 16.1 ± 2.9 years and 69% were male. The average training time was 5.8 hours per week. In the population, 319 (57.6%) subjects practiced an endurance sport vs. 235 (42.4%) subjects who practiced a resistance sport. Sinus bradycardia was noted in 70 (21.9%) endurance athletes vs. 30 (12.8%) resistance athletes (p = 0.005). Long PR interval was recorded in 12 endurance athletes vs. 3 cases among resistance athletes (p = 0.046). A right bundle branch bloc was reported more frequently among endurance athletes: 55 (17.2%) vs. 22 (9.4%); (p = 0.004). The mean value of the Sokolow-Lyon index was 31.51 ± 10.34 mm in endurance athletes vs. 29.72 ± 9.41 mm in resistance athletes (p = 0.037). Systolic ejection fraction was significantly lower in endurance athletes compared to resistance athletes (66.08 ± 4.73% vs. 68.1 ± 4.90%; p = 0.005). CONCLUSIONS This study showed that electrical abnormalities in athletes, considered physiological, are more frequent among endurance athletes. Therefore, sport-specific criteria need to be developed for a more appropriate approach to screening for electrical abnormalities in athletes.
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Affiliation(s)
| | - Ghariani Anis
- Service de cardiologie, Centre hospital-universitaire Farhat Hached, Sousse, Tunisie.
| | - Fekih Romdhane Ahmed
- Service de cardiologie, Centre hospital-universitaire Farhat Hached, Sousse, Tunisie
| | - Ben Ameur Zied
- Service de cardiologie, Centre hospital-universitaire Farhat Hached, Sousse, Tunisie
| | - Bouraoui Hatem
- Service de cardiologie, Centre hospital-universitaire Farhat Hached, Sousse, Tunisie
| | - Abdelah Mahdhaoui
- Service de cardiologie, Centre hospital-universitaire Farhat Hached, Sousse, Tunisie; Université de Sousse, Laboratoire de recherche : LR14ES05 : Interaction du système cardio-pulmonaire, Faculté de Médecine de Sousse, Tunisie
| | - Ernez-Hajri Samia
- Service de cardiologie, Centre hospital-universitaire Farhat Hached, Sousse, Tunisie; Hôpital Farhat Hached de Sousse, Laboratoire de recherche : LRSP09 : Insuffisance cardiaque, Tunisie
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Cai S, Zheng L, Yao Y. Selection of patients with symptomatic vagal-induced sinus node dysfunction: Who will be the best candidate for cardioneuroablation? Front Physiol 2023; 14:1088881. [PMID: 36824466 PMCID: PMC9942778 DOI: 10.3389/fphys.2023.1088881] [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: 11/03/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
Sinus node dysfunction is a multifaceted disorder with variable manifestations, the prevalence of which increases with age. In a specific group of patients, excessive vagal activity may be the sole cause for this condition. These patients are characterized as having recurrent daytime symptoms attributed to bradyarrhythmia, no evidence of organic sinus node lesions, cardiac vagal overactivation, and are non-elderly. For sinus node dysfunction patients, a permanent pacemaker implantation appears to be the ultimate solution, although it is not an etiological treatment. Cardioneuroablation is a promising emerging therapy that can fundamentally eliminate symptoms in a highly selective sub-set of sinus node dysfunction patients by cardiac vagal nerve denervation. Denervation with ablation for vagal-induced sinus node dysfunction can effectively improve sinus bradycardia and reduce syncope. To date, guidelines for selection of suitable candidates for cardioneuroablation remain lacking. The primary objective of this study was to distinguish the nature of abnormal sinus node function and to find methods for quantifying vagal tone. Clear selection criteria could help physicians in identification of patients with autonomic imbalance, thereby maximizing patient benefits and the success rate of cardioneuroablations.
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Affiliation(s)
- Simin Cai
- Cardiac Arrhythmia Center, Heart Center, The People’s Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Huazhong Fuwai Hospital, Zhengzhou, Henan, China
| | - Lihui Zheng
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China,*Correspondence: Lihui Zheng, ; Yan Yao,
| | - Yan Yao
- Cardiac Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China,*Correspondence: Lihui Zheng, ; Yan Yao,
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Singh GK, McClenaghan C, Aggarwal M, Gu H, Remedi MS, Grange DK, Nichols CG. A Unique High-Output Cardiac Hypertrophy Phenotype Arising From Low Systemic Vascular Resistance in Cantu Syndrome. J Am Heart Assoc 2022; 11:e027363. [PMID: 36515236 PMCID: PMC9798820 DOI: 10.1161/jaha.122.027363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/25/2022] [Indexed: 12/15/2022]
Abstract
Background Cardiomegaly caused by left ventricular hypertrophy is a risk factor for development of congestive heart failure, classically associated with decreased systolic and/or diastolic ventricular function. Less attention has been given to the phenotype of left ventricular hypertrophy with enhanced ventricular function and increased cardiac output, which is potentially associated with high-output heart failure. Lack of recognition may pose diagnostic ambiguity and management complexities. Methods and Results We sought to systematically characterize high-output cardiac hypertrophy in subjects with Cantu syndrome (CS), caused by gain-of-function variants in ABCC9, which encodes cardiovascular KATP (ATP-sensitive potassium) channel subunits. We studied the cardiovascular phenotype longitudinally in 31 subjects with CS with confirmed ABCC9 variants (median [interquartile range] age 8 years [3-32 years], body mass index 19.9 [16.5-22.9], 16 male subjects). Subjects with CS presented with significant left ventricular hypertrophy (left ventricular mass index 86.7 [57.7-103.0] g/m2 in CS, n=30; 26.6 [24.1-32.8] g/m2 in controls, n=17; P<0.0001) and low blood pressure (systolic 94.5 [90-103] mm Hg in CS, n=17; 109 [98-115] mm Hg in controls, n=17; P=0.0301; diastolic 60 [56-66] mm Hg in CS, n=17; 69 [65-72] mm Hg in control, n=17; P=0.0063). Most (21/31) subjects with CS exhibited eccentric hypertrophy with normal left ventricular wall thickness. Congestive heart failure symptoms were evident in 4 of the 5 subjects with CS aged >40 years on long-term follow-up. Conclusions The data define the natural history of high-output cardiac hypertrophy resulting from decreased systemic vascular resistance in subjects with CS, a defining population for long-term consequences of high-output hypertrophy caused by low systemic vascular resistance, and the potential for progression to high-output heart failure.
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Affiliation(s)
- Gautam K. Singh
- Division of Cardiology, Department of PediatricsWashington University School of MedicineSt. LouisMO
- Center for the Investigation of Membrane Excitability Diseases (CIMED)Washington University School of MedicineSt. LouisMO
| | - Conor McClenaghan
- Center for the Investigation of Membrane Excitability Diseases (CIMED)Washington University School of MedicineSt. LouisMO
- Department of Cell Biology and PhysiologyWashington University School of MedicineSt. LouisMO
| | - Manish Aggarwal
- Division of Cardiology, Department of PediatricsWashington University School of MedicineSt. LouisMO
| | - Hongjie Gu
- Division of StatisticsWashington University School of MedicineSt. LouisMO
| | - Maria S. Remedi
- Center for the Investigation of Membrane Excitability Diseases (CIMED)Washington University School of MedicineSt. LouisMO
- Department of Medicine, Division of EndocrinologyWashington University School of MedicineSt. LouisMO
| | - Dorothy K. Grange
- Center for the Investigation of Membrane Excitability Diseases (CIMED)Washington University School of MedicineSt. LouisMO
- Department of Pediatrics, Division of GeneticsWashington University School of MedicineSt. LouisMO
| | - Colin G. Nichols
- Center for the Investigation of Membrane Excitability Diseases (CIMED)Washington University School of MedicineSt. LouisMO
- Department of Cell Biology and PhysiologyWashington University School of MedicineSt. LouisMO
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Soós I, Borysławski K, Boraczyński M, Ihasz F, Podstawski R. Anthropometric and Physiological Profiles of Hungarian Youth Male Soccer Players of Varying Ages and Playing Positions: A Multidimensional Assessment with a Critical Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11041. [PMID: 36078756 PMCID: PMC9518191 DOI: 10.3390/ijerph191711041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND This study aimed to create preliminary anthropometric and physiological profiles of Hungarian male soccer players belonging to different age categories (14, 15, 16, and 17-18-years) and assigned to different playing positions (forward, defender, midfielder, goalkeeper). METHODS Anthropometric and physiological profiles were created for four age groups: 14- (n = 20), 15- (n = 16), 16- (n = 22) and 17-18-year-olds (n = 23) representing the Hungarian soccer academy. Additionally, the variables were analyzed across the four player positions mentioned above. RESULTS The mean values of body mass, fat mass and BMI were within normal limits, although in some cases the anthropometric and body composition values were too high, particularly among the 17-18-year-olds. The mean values of HRrest were lowest among the 15-year-olds. The highest mean and maximal values of rVO2max and rVO2/AT [57.6 ± 8.12 (43.8-68.3) and 51.2 ± 7.24 (38.9-60.8) mL/kg/min, respectively] were noted in 14-year-olds. Goalkeepers performed significantly better than the remaining soccer players in terms of the most anthropometric and physiological characteristics, except for the Yo-Yo test (p < 0.001). CONCLUSIONS The values of anthropometric parameters increased with age. As expected, the oldest group achieved the best results in the performance tests. Goalkeepers outperformed the players representing other playing positions in the tests when assessing lower limb strength, sprint performance (5- and 10-m distance), and agility tests. From a practical point of view, the presented anthropometric and physiological profiles of players representing different age groups and playing positions can be useful for soccer coaches, strength and conditioning specialists, and athletic trainers of other soccer clubs in terms of the individualization and optimalization of soccer training.
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Affiliation(s)
- Imre Soós
- Faculty of Health Sciences, Doctoral School of Health Sciences, University of Pécs, H-7622 Pécs, Hungary
| | | | - Michał Boraczyński
- Faculty of Health Sciences, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland
| | - Ferenc Ihasz
- Faculty of Psychology and Pedagogy, Institute of Sports Sciences, Eötvös Lóránd University, 9700 Szombathely, Hungary
| | - Robert Podstawski
- Department of Tourism, Recreation and Ecology, University of Warmia and Mazury in Olsztyn, 10-957 Olsztyn, Poland
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Gajda R, Knechtle B, Gębska-Kuczerowska A, Gajda J, Stec S, Krych M, Kwaśniewska M, Drygas W. Amateur Athlete with Sinus Arrest and Severe Bradycardia Diagnosed through a Heart Rate Monitor: A Six-Year Observation-The Necessity of Shared Decision-Making in Heart Rhythm Therapy Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610367. [PMID: 36012002 PMCID: PMC9408438 DOI: 10.3390/ijerph191610367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 05/14/2023]
Abstract
Heart rate monitors (HRMs) are used by millions of athletes worldwide to monitor exercise intensity and heart rate (HR) during training. This case report presents a 34-year-old male amateur soccer player with severe bradycardia who accidentally identified numerous pauses of over 4 s (maximum length: 7.3 s) during sleep on his own HRM with a heart rate variability (HRV) function. Simultaneous HRM and Holter ECG recordings were performed in an outpatient clinic, finding consistent 6.3 s sinus arrests (SA) with bradycardia of 33 beats/min. During the patient's hospitalization for a transient ischemic attack, the longest pauses on the Holter ECG were recorded, and he was suggested to undergo pacemaker implantation. He then reduced the volume/intensity of exercise for 4 years. Afterward, he spent 2 years without any regular training due to depression. After these 6 years, another Holter ECG test was performed in our center, not confirming the aforementioned disturbances and showing a tendency to tachycardia. The significant SA was resolved after a period of detraining. The case indicates that considering invasive therapy was unreasonable, and patient-centered care and shared decision-making play a key role in cardiac pacing therapy. In addition, some sports HRM with an HRV function can help diagnose bradyarrhythmia, both in professional and amateur athletes.
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Affiliation(s)
- Robert Gajda
- Center for Sports Cardiology, Gajda-Med Medical Center, ul. Piotra Skargi 23/29, 06-100 Pułtusk, Poland
- Department of Kinesiology and Health Prevention, Jan Dlugosz University, 42-200 Czestochowa, Poland
- Correspondence: ; Tel.: +48-604286030
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, 8091 Zurich, Switzerland
- Medbase St. Gallen Am Vadianplatz, 9000 St. Gallen, Switzerland
| | - Anita Gębska-Kuczerowska
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Kazimierza Wóycickiego 1/3, 01-938 Warsaw, Poland
| | - Jacek Gajda
- Center for Sports Cardiology, Gajda-Med Medical Center, ul. Piotra Skargi 23/29, 06-100 Pułtusk, Poland
| | - Sebastian Stec
- Division of Electrophysiology, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Subcarpathian Center for Cardiovascular Intervention, 38-500 Sanok, Poland
| | - Michalina Krych
- Department of Congenital Heart Diseases, The Cardinal Stefan Wyszyński National Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw, Poland
| | - Magdalena Kwaśniewska
- Department of Preventive Medicine, Faculty of Health, Medical University of Lodz, ul. Lucjana Żeligowskiego 7/9, 90-752 Łódź, Poland
| | - Wojciech Drygas
- Department of Congenital Heart Diseases, The Cardinal Stefan Wyszyński National Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw, Poland
- Department of Preventive Medicine, Faculty of Health, Medical University of Lodz, ul. Lucjana Żeligowskiego 7/9, 90-752 Łódź, Poland
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Broadwater DR, Krause KA, Lynch DT, Kendelhardt JD. Are Bradycardic Donors More Likely to Have Adverse Outcomes During Blood Donation? Mil Med 2021; 188:e1018-e1021. [PMID: 34668966 DOI: 10.1093/milmed/usab416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/10/2021] [Accepted: 10/13/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION In order to decrease adverse donor reactions during blood donation, volunteers are screened to safely donate according to the U.S. Food and Drug Administration standards. Volunteers must be normocardic, with a pulse between 50 and 100 beats per minute. Bradycardic volunteers with a pulse lower than 50 beats per minute who otherwise meet requirements may donate with physician approval. Blood donors in military settings tend to be younger and more physically fit than the average donor population, resulting in a higher percentage of bradycardic donors. The relationship between bradycardia and adverse donor reactions has not been well studied. Herein, we aim to compare post-donation adverse reactions and the ability to complete donation between normocardic and bradycardic donors. MATERIALS AND METHODS Institutional review board approval was obtained. Records from a single blood donor center located on a large military installation in 2019 were retrospectively reviewed for vital signs, demographics, hemoglobin, and donor reactions. Donors were categorized as normocardic or bradycardic. The two groups were statistically compared using a χ2 test. RESULTS Of the 1,601 donors in the study period, 1,514 qualified for donation. Mean age was 26.6 years (range, 17-72 years), with a male to female ratio of 2.1:1. Of these, 1,478 were normocardic and 26 were bradycardic. There was no significant difference in adverse reactions between the two groups (5.6% in bradycardic donors versus 3.6% in normocardic donors, n = 1,514, χ21 = 0.39, P = .53) or percentage of incomplete donations (5.9% in bradycardic and 5.65% in normocardic, n = 1,514, χ21 = 0.003, P = .96). CONCLUSIONS Donors with bradycardia are as safe to donate as normocardic donors. In the absence of comorbidities, blood donor centers should ensure their policies consider donation for volunteers with bradycardia.
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Affiliation(s)
- Devin R Broadwater
- Department of Pathology and Area Laboratory Services, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), San Antonio, TX 78234, USA
| | - Katherine A Krause
- Department of Pathology and Area Laboratory Services, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), San Antonio, TX 78234, USA
| | - David T Lynch
- Department of Pathology and Area Laboratory Services, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), San Antonio, TX 78234, USA
| | - Jason D Kendelhardt
- Department of Pathology and Area Laboratory Services, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), San Antonio, TX 78234, USA
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Jörres M, Gunga HC, Steinach M. Physiological Changes, Activity, and Stress During a 100-km-24-h Walking-March. Front Physiol 2021; 12:640710. [PMID: 33776795 PMCID: PMC7991843 DOI: 10.3389/fphys.2021.640710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background Long-endurance exercises like ultramarathons are known to elicit various metabolic and physiological changes in the human body. However, little is known about very long-duration exercise at low intensities regarding healthy human subjects. Aim The purpose of this study was to evaluate changes in body composition and metabolism in long-endurance but low-intensity events. Methods Twenty-five male and 18 female healthy recreational athletes (age 34.6 ± 8.8 years; BMI: 22.4 ± 2.0 kg/m2) of the "100 km Mammutmarsch" were recruited for participation during the events in 2014-2016. Other than classical ultramarathons, the "Mammutmarsch" is a hiking event, in which participants were required to walk but not run or jog. It was expected to complete the 100-km distance within 24 h, resulting in a calculated mean speed of 4.17 km/h, which fits to the mean speed observed (4.12 ± 0.76 km/h). As not all participants reached the finish line, comparison of finishers (FIN, n = 11) and non-finishers (NON, n = 21) allowed differential assessment of performance. Body composition measured through bioelectrical impedance analysis (BIA) was determined pre- and post-event, and serum samples were taken pre-event, at 30, 70, and 100 km to determine NT-pro-BNP, troponin T, C-reactive protein (CRP), cortisol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides, total cholesterol, total creatine kinase (CK), CK-MB, aminotransferase (AST), ALT, and sodium levels. Nineteen participants wore actimeter armbands (SenseWear®) to gain information about body activity and exercise intensity [metabolic equivalent of task (MET)]. Sixteen participants wore mobile heart rate monitors to assess mean heart rate during the race. Serum parameter alterations over the course of the race were analyzed with mixed-effects ANOVA and additional t-tests. All serum parameters were analyzed for correlation concerning different MET levels, speed, age, BMI, baseline NT-pro-BNP, mean heart rate during the race, and sex with linear regression analysis. Results We found significant elevations for muscle and cardiac stress markers (CRP, CK, CK-MB, AST, ALT, cortisol, and NT-pro-BNP) as well as decreasing markers of lipid metabolism (cholesterol, triglycerides, LDL). Although the intensity level demanded from our participants was low compared with other studies on (ultra-) marathons, the alteration of tested parameters was similar to those of high-intensity exercise, e.g., NT-pro-BNP showed a fourfold increase (p < 0.01) and LDL decreased by 20% (p = 0.05). Besides the duration of exercise, age, BMI, training status, and sex are relevant parameters that influence the elevation of stress factors. Notably, our data indicate that NT-pro-BNP might be a marker for cardiovascular fitness also in healthy adults. Conclusion This low-intensity long-endurance walk evoked a strong systemic reaction and large cell stress and shifted to a favorable lipid profile, comparable to higher intensity events. Despite increasing cardiac stress parameters, there were no indications of cardiac cell damage. Remarkably, the duration seems to have a greater influence on stress markers and metabolism than intensity.
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Affiliation(s)
- Marc Jörres
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments, Berlin, Germany
| | - Hanns-Christian Gunga
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments, Berlin, Germany
| | - Mathias Steinach
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology, Center for Space Medicine and Extreme Environments, Berlin, Germany
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Gajda R. Is Continuous ECG Recording on Heart Rate Monitors the Most Expected Function by Endurance Athletes, Coaches, and Doctors? Diagnostics (Basel) 2020; 10:diagnostics10110867. [PMID: 33114156 PMCID: PMC7690815 DOI: 10.3390/diagnostics10110867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
Heart rate monitors (HRMs) are important for measuring heart rate, which can be used as a training parameter for healthy athletes. They indicate stress-related heart rhythm disturbances—recognized as an unexpected increase in heart rate (HR)—which can be life-threatening. Most HRMs confuse arrhythmias with artifacts. This study aimed to assess the usefulness of electrocardiogram (ECG) recordings from sport HRMs for endurance athletes, coaches, and physicians, compared with other basic and hypothetical functions. We conducted three surveys among endurance athletes (76 runners, 14 cyclists, and 10 triathletes), 10 coaches, and 10 sports doctors to obtain information on how important ECG recordings are and what HRM functions should be improved to meet their expectations in the future. The respondents were asked questions regarding use and hypothetical functions, as well as their preference for HRM type (optical/strap). Athletes reported distance, pace, instant HR, and oxygen threshold as being the four most important functions. ECG recording ranked eighth and ninth for momentary and continuous recording, respectively. Coaches placed more importance on ECG recording. Doctors ranked ECG recording the highest. All participants preferred optical HRMs to strap HRMs. Research on the improvement and implementation of HRM functions showed slightly different preferences for athletes compared with coaches and doctors. In cases where arrhythmia was suspected, the value of the HRM’s ability to record ECGs during training by athletes and coaches increased. For doctors, this is the most desirable feature in any situation. Considering the expectations of all groups, continuous ECG recording during training will significantly improve the safety of athletes.
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Affiliation(s)
- Robert Gajda
- Center for Sports Cardiology at the Gajda-Med Medical Center in Pułtusk, ul. Piotra Skargi 23/29, 06-100 Pułtusk, Poland
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