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Orchard J, Harmon KG, D'Ascenzi F, Meyer T, Pieles GE. What is the most appropriate age for the first cardiac screening of athletes? J Sci Med Sport 2024; 27:583-593. [PMID: 38890019 DOI: 10.1016/j.jsams.2024.05.017] [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: 02/15/2024] [Revised: 05/20/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024]
Abstract
For sporting organisations that conduct screening of athletes, there are very few consistent guidelines on the age at which to start. Our review found the total rate of sudden cardiac arrest or death is very low between the ages of 8-11 years (less than 1/100,000/year), increasing to 1-2/100,000/year in both elite athletes and community athletes aged 12-15 years and then steadily increases with age. The conditions associated with sudden cardiac death in paediatric athletes and young adult athletes are very similar with some evidence that death from coronary artery abnormalities occurs more frequently in athletes 10-14 years old. The decision when to begin a screening program involves a complex interplay between requirements and usual practices in a country, the rules of different leagues and programs, the age of entry into an elite program, the underlying risk of the population and the resources available. Given the incidence of sudden cardiac arrest or death in young people, we recommend beginning cardiac screening no earlier than 12 years (not later than 16 years). The risk increases with age, therefore, starting a program at any point after age 12 has added value. Importantly, anyone with concerning symptoms (e.g. collapse on exercise) or family history of an inherited cardiac condition should see a physician irrespective of age. Finally, no screening program can capture all abnormalities, and it is essential for organisations to implement a cardiac emergency plan including training on recognition and response to sudden cardiac arrest and prompt access to resuscitation, including defibrillators.
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Affiliation(s)
- Jessica Orchard
- Sydney School of Public Health, The University of Sydney, Australia. https://twitter.com/jessicajorchard
| | | | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Sports Cardiology and Rehab Unit, University of Siena, Italy. https://twitter.com/FlavioDascenzi
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Germany. https://twitter.com/ProfTim_Meyer
| | - Guido E Pieles
- Department of Athlete Screening and Sports Cardiology, Aspetar Orthopaedic and Sports Medicine Hospital, Qatar; Institute of Sport, Exercise and Health, University College London, UK.
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2
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Penela D, Tritto M, Guasch E. Unlocking electrocardiogram secrets: understanding low QRS voltages in limb leads. Eur J Prev Cardiol 2024; 31:1104-1105. [PMID: 38466014 DOI: 10.1093/eurjpc/zwae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Diego Penela
- Humanitas Research Center, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - Massimo Tritto
- Humanitas Research Center, Via Manzoni 56, Rozzano, Milan 20089, Italy
| | - Eduard Guasch
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
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3
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Sarquella-Brugada G, Martínez-Barrios E, Cesar S, Toro R, Cruzalegui J, Greco A, Díez-Escuté N, Cerralbo P, Chipa F, Arbelo E, Diez-López C, Grazioli G, Balderrábano N, Campuzano O. A narrative review of inherited arrhythmogenic syndromes in young population: role of genetic diagnosis in exercise recommendations. BMJ Open Sport Exerc Med 2024; 10:e001852. [PMID: 38975025 PMCID: PMC11227825 DOI: 10.1136/bmjsem-2023-001852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/09/2024] Open
Abstract
Sudden cardiac death is a rare but socially devastating event, especially if occurs in young people. Usually, this unexpected lethal event occurs during or just after exercise. One of the leading causes of sudden cardiac death is inherited arrhythmogenic syndromes, a group of genetic entities characterised by incomplete penetrance and variable expressivity. Exercise can be the trigger for malignant arrhythmias and even syncope in population with a genetic predisposition, being sudden cardiac death as the first symptom. Due to genetic origin, family members must be clinically assessed and genetically analysed after diagnosis or suspected diagnosis of a cardiac channelopathy. Early identification and adoption of personalised preventive measures is crucial to reduce risk of arrhythmias and avoid new lethal episodes. Despite exercise being recommended by the global population due to its beneficial effects on health, particular recommendations for these patients should be adopted considering the sport practised, level of demand, age, gender, arrhythmogenic syndrome diagnosed but also genetic diagnosis. Our review focuses on the role of genetic background in sudden cardiac death during exercise in child and young population.
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Affiliation(s)
- Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
- Medical Science Department, School of Medicine, Universitat de Girona, Girona, Spain
| | - Estefanía Martínez-Barrios
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Sergi Cesar
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Rocío Toro
- Medicine Department, School of Medicine, University of Cádiz, Cádiz, Spain
| | - José Cruzalegui
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Andrea Greco
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Nuria Díez-Escuté
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Patricia Cerralbo
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Fredy Chipa
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Elena Arbelo
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, The Netherlands
- 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, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Carles Diez-López
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat, Barcelona, Spain
- Advanced Heart Failure and Heart Transplant Unit, Department of Cardiology, Bellvitge University Hospital Hospitalet de Llobregat, Barcelona, Spain
| | | | - Norma Balderrábano
- Cardiology Department, Children Hospital of Mexico Federico Gómez, México D.F, Mexico
| | - Oscar Campuzano
- Medical Science Department, School of Medicine, Universitat de Girona, Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdiques de Girona (IDIBGI), Salt-Girona, Spain
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Hirai K, Sakano N, Oozawa S, Ousaka D, Kuroko Y, Kasahara S. Initial trial of three‑lead wearable electrocardiogram monitoring in a full marathon. J Cardiol Cases 2024; 30:24-28. [PMID: 39007048 PMCID: PMC11245758 DOI: 10.1016/j.jccase.2024.03.004] [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: 01/09/2024] [Revised: 02/18/2024] [Accepted: 03/27/2024] [Indexed: 07/16/2024] Open
Abstract
Sudden cardiac arrest during exercise can occur without prior warning signs at rest, highlighting the importance of monitoring for its prevention. To detect the signs of ischemic heart disease, including coronary artery anomalies, ST changes must be detected using three‑lead electrocardiograms (ECGs) corresponding to each region of the three coronary artery branches. We conducted ECG monitoring of five runners during a marathon using a wearable three‑lead ECG device (e-skin ECG; Xenoma Inc., Tokyo, Japan). Data without noise or artifacts were successfully collected for one of five runners during the entire marathon. Within the initial hour of the marathon, poor electrode adhesion to the skin hindered the data collection for the remaining four runners, which resulted in significantly decreased acquisition rate compared with the first hour (86.7 ± 13.4 % to 37.3 ± 36.9 %, p = 0.028). Couplets of premature ventricular contractions with clear ECG waveforms in the three leads were detected in one runner during the marathon. Further device improvements are necessary to enable marathon runners to obtain ECGs efficiently without affecting their performance. This study also demonstrated the potential applications of three‑lead wearable ECG monitoring for other short-duration sports and remote home-based cardiac rehabilitation. Learning objective This is an initial trial of a three‑lead wearable electrocardiogram (ECG) monitoring device during a full marathon. ECG data were obtained with low noise and artifacts during the first hour of the marathon; however, the data acquisition rate decreased in the middle and late stages owing to poor electrode adhesion. This study demonstrated the possibility of applying wearable ECG monitoring during short-term exercise and cardiac rehabilitation to detect warning signs and prevent sudden cardiac arrest.
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Affiliation(s)
- Kenta Hirai
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Noriko Sakano
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Susumu Oozawa
- Department of Clinical Safety, Okayama University Hospital, Okayama, Japan
| | - Daiki Ousaka
- Department of Pharmacology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Yosuke Kuroko
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
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5
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Yodoya N, Sawada H, Mitani Y, Ohashi H, Tsuboya N, Ohya K, Takeoka M, Hayakawa H, Hirayama M. School electrocardiography screening program prompts the detection of otherwise unrecognized atrial septal defect in children in Japan. Front Pediatr 2024; 12:1396853. [PMID: 38887565 PMCID: PMC11180781 DOI: 10.3389/fped.2024.1396853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/14/2024] [Indexed: 06/20/2024] Open
Abstract
Background Atrial septal defect (ASD) is a congenital heart disease that often presents without symptoms or murmurs. If left untreated, children with ASD can develop comorbidities in adulthood. In Japan, school electrocardiography (ECG) screening has been implemented for all 1st, 7th, and 10th graders. However, the impact of this program in detecting children with ASD is unknown. Methods This is a retrospective study that analyzed consecutive patients with ASD who underwent catheterization for surgical or catheter closure at ≤18 years of age during 2009-2019 at a tertiary referral center in Japan. Results Of the overall 116 patients with ASD (median age: 3.0 years of age at diagnosis and 8.9 years at catheterization), 43 (37%) were prompted by the ECG screening (Screening group), while the remaining 73 (63%) were by other findings (Non-screening group). Of the 49 patients diagnosed at ≥6 years of age, 43 (88%) were prompted by the ECG screening, with the 3 corresponding peaks of the number of patients at diagnosis. Compared with the non-screening group, the screening group exhibited similar levels of hemodynamic parameters but had a lower proportion of audible heart murmur, which were mainly prompted by the health care and health checkups in infancy or preschool period. Patients positive for a composite parameter (rsR' type of iRBBB, inverted T in V4, or ST depression in the aVF lead) accounted for 79% of the screening group at catheterization, each of which was correlated with hemodynamic parameters in the overall patients. Conclusions The present study shows that school ECG screening detects otherwise unrecognized ASD, which prompted the diagnosis of the majority of patients at school age and >one-third of overall patients in Japan. These findings suggest that ECG screening program could be an effective strategy for detecting hemodynamically significant ASD in students, who are asymptomatic and murmurless.
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Affiliation(s)
| | | | - Yoshihide Mitani
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
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6
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Ferrari F, da Silveira AD, Ziegelmann PK, Aleixo H, Dilda GD, Emed LGM, Magalhães FCO, Cardoso FB, da Silva HC, Guerra FEF, Soares LG, Bassan F, Braga F, Herdy AH, Froelicher V, Stein R. Imaging associations enhance the understanding of ECG abnormalities in male Brazilian football players: findings from the B-Pro Foot ECG study. Br J Sports Med 2024; 58:598-605. [PMID: 38621858 DOI: 10.1136/bjsports-2023-108053] [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] [Accepted: 03/29/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES To evaluate the prevalence of abnormal ECG findings and their association with imaging results in male Brazilian football players. METHODS The 'B-Pro Foot ECG' is a multicentre observational study conducted in 82 Brazilian professional clubs. It analysed 6125 players aged 15-35 years (2496 white, 2004 mixed-race and 1625 black individuals) who underwent cardiovascular screening from 2002 to 2023. All ECGs were reviewed by two experienced cardiologists in the athlete's care. Those with abnormal findings underwent further investigations, including a transthoracic echocardiogram (TTE). Cardiac magnetic resonance (CMR) was subsequently performed based on TTE findings or clinical suspicion. RESULTS In total, 180 (3%) players had abnormal ECGs and 176 (98%) showed normal TTE results. Athletes aged 26-35 years had a higher prevalence of abnormal ECGs than younger athletes (15-25 years). Black players had a higher prevalence of T-wave inversion (TWI) in the inferior leads than white players (2.6% vs 1.4%; p=0.005), as well as in V5 (2.9%) and V6 (2.1%) compared with white (1.2% and 1.0%; p<0.001) and mixed-race (1.5% and 1.2%; p<0.05) players, respectively. TTE parameters were similar across ethnicities. However, four out of 75 players with inferolateral TWI showed abnormal TTEs and CMR findings consistent with cardiomyopathies. CMR also showed cardiomyopathies or myocarditis in four players with inferolateral TWI and normal TTEs. In total, nine (0.1%) athletes were diagnosed with cardiac diseases and were followed for 40±30 months, with no cardiac events documented. CONCLUSION This study found a 3% prevalence of abnormal ECGs in male Brazilian football players. Inferolateral TWI was associated with cardiac pathologies confirmed by CMR, even in athletes with a normal TTE.
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Affiliation(s)
- Filipe Ferrari
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Anderson D da Silveira
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Science, Health and Performance Department, Grêmio Foot-Ball Porto Alegrense, Porto Alegre, RS, Brazil
| | - Patrícia K Ziegelmann
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Graduate Program in Epidemiology, Department of Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Haroldo Aleixo
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Luiz G M Emed
- Instituto de Neurologia de Curitiba, Curitiba, PR, Brazil
| | | | | | | | | | - Luciano G Soares
- Clínica Biocorfit Reabilitação Cardíaca Pulmonar e Metabólica, Goiânia, GO, Brazil
| | - Fernando Bassan
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil
| | - Fabrício Braga
- Laboratorio de Performance Humana, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Artur H Herdy
- Instituto de Cardiologia de Santa Catarina, Florianópolis, SC, Brazil
| | - Victor Froelicher
- Department of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA
| | - Ricardo Stein
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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7
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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
- Yale University School of Medicine, New Haven, Connecticut
| | | | - 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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8
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Graziano F, Bondarev S, Corrado D, Zorzi A. The Challenges of Screening Master Athletes. Cardiology 2024:1-4. [PMID: 38574487 DOI: 10.1159/000538326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Sergei Bondarev
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
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9
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Graziano F, Schiavon M, Cipriani A, Savalla F, De Gaspari M, Bauce B, Rizzo S, Calore C, Thiene G, Paiaro S, Basso C, Zorzi A. Causes of sudden cardiac arrest and death and the diagnostic yield of sport preparticipation screening in children. Br J Sports Med 2024; 58:255-260. [PMID: 38233088 PMCID: PMC10958295 DOI: 10.1136/bjsports-2023-107357] [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] [Accepted: 01/01/2024] [Indexed: 01/19/2024]
Abstract
OBJECTIVE Evidence on the increased risk of sports-related sudden cardiac arrest and death (SCA/D) and the potential benefit of cardiovascular preparticipation screening (PPS) in children is limited. We assessed the burden and circumstances of SCA/D and the diagnostic yield of cardiovascular PPS in children aged 8-15 years. METHODS Data on the incidence and causes of SCA/D from 2011 to 2020 were obtained from the Veneto region (Italy) sudden death registry, hospital records and local press. During the same period, we assessed the results of annual PPS in 25 251 young competitive athletes aged 8-15 years who underwent 58 185 evaluations (mean 2.3/athlete) in Padua, Italy. RESULTS Over 10 years, 26 SCA/D occurred in children aged 8-15 years in the Veneto region: 6 in athletes (incidence 0.7/100 000/year, all ≥12 years) versus 20 in non-athletes (0.7/100 000/year, 17/20 ≥12 years). In total, 4/6 athletes versus 1/20 non-athletes survived. The cause of SCA/D remained unexplained in four athletes and in nine non-athletes. No athlete suffered SCA/D from structural diseases potentially identifiable by PPS. The incidence of SCA/D in athletes and non-athletes was 0.2/100 000/year in the 8-11 years group versus 1.3/100 000/year in the 12-15 years group. PPS identified 26 new diagnoses of cardiovascular diseases (CVDs) at risk of SCA/D, more often in children ≥12 years old (0.06%/evaluation) than <12 years old (0.02%/evaluation, p=0.02). Among athletes with a negative PPS, two suffered unexplained SCA/D during follow-up, one during exercise. CONCLUSIONS In children aged 8-15 years, the incidence of SCA/D and the yield of PPS for identifying at-risk CVD were both substantially higher in those ≥12 years, suggesting that systematic PPS may be more useful beyond this age.
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Affiliation(s)
- Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | | | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
| | | | - Monica De Gaspari
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
| | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
| | - Stefania Rizzo
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
| | - Chiara Calore
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
| | | | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
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10
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Gianni A, Botteri M, Stirparo G, Mattesi G, Zorzi A, Villa GF. The impact of the Italian law mandating an automatic external defibrillator in all sports venues on sudden cardiac arrest resuscitation rates. Eur J Prev Cardiol 2024; 31:e16-e18. [PMID: 37758503 DOI: 10.1093/eurjpc/zwad313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/04/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Alessandro Gianni
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Via Giustiniani, 2, Padova 35128, Italy
| | | | | | - Giulia Mattesi
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Via Giustiniani, 2, Padova 35128, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Via Giustiniani, 2, Padova 35128, Italy
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Compagnucci P, Selimi A, Cipolletta L, Volpato G, Gasperetti A, Valeri Y, Parisi Q, Curcio A, Natale A, Dello Russo A, Casella M. Arrhythmic Mitral Valve Prolapse and Sports Activity: Pathophysiology, Risk Stratification, and Sports Eligibility Assessment. J Clin Med 2024; 13:1350. [PMID: 38592178 PMCID: PMC10932446 DOI: 10.3390/jcm13051350] [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: 01/09/2024] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
Although mitral valve prolapse (MVP) is the most prevalent valvular abnormality in Western countries and generally carries a good prognosis, a small subset of patients is exposed to a significant risk of malignant ventricular arrhythmias (VAs) and sudden cardiac death (SCD), the so-called arrhythmic MVP (AMVP) syndrome. Recent work has emphasized phenotypical risk features of severe AMVP and clarified its pathophysiology. However, the appropriate assessment and risk stratification of patients with suspected AMVP remains a clinical conundrum, with the possibility of both overestimating and underestimating the risk of malignant VAs, with the inappropriate use of advanced imaging and invasive electrophysiology study on one hand, and the catastrophic occurrence of SCD on the other. Furthermore, the sports eligibility assessment of athletes with AMVP remains ill defined, especially in the grey zone of intermediate arrhythmic risk. The definition, epidemiology, pathophysiology, risk stratification, and treatment of AMVP are covered in the present review. Considering recent guidelines and expert consensus statements, we propose a comprehensive pathway to facilitate appropriate counseling concerning the practice of competitive/leisure-time sports, envisioning shared decision making and the multidisciplinary "sports heart team" evaluation of borderline cases. Our final aim is to encourage an active lifestyle without compromising patients' safety.
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Affiliation(s)
- Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy; (A.S.); (L.C.); (G.V.); (Y.V.); (Q.P.); (A.D.R.)
| | - Adelina Selimi
- Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy; (A.S.); (L.C.); (G.V.); (Y.V.); (Q.P.); (A.D.R.)
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy;
| | - Laura Cipolletta
- Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy; (A.S.); (L.C.); (G.V.); (Y.V.); (Q.P.); (A.D.R.)
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy; (A.S.); (L.C.); (G.V.); (Y.V.); (Q.P.); (A.D.R.)
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy;
| | - Alessio Gasperetti
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy;
- Department of Cardiology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Yari Valeri
- Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy; (A.S.); (L.C.); (G.V.); (Y.V.); (Q.P.); (A.D.R.)
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy;
| | - Quintino Parisi
- Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy; (A.S.); (L.C.); (G.V.); (Y.V.); (Q.P.); (A.D.R.)
| | - Antonio Curcio
- Division of Cardiology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin, TX 78705, USA;
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA 92037, USA
- Department of Internal Medicine, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44195, USA
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy; (A.S.); (L.C.); (G.V.); (Y.V.); (Q.P.); (A.D.R.)
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy;
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy; (A.S.); (L.C.); (G.V.); (Y.V.); (Q.P.); (A.D.R.)
- Department of Medical, Special and Dental Sciences, Marche Polytechnic University, 60121 Ancona, Italy
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12
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Martini N, Martini B, Corrado D, Zorzi A. Interpolated junctional extrasystoles mimicking complex polymorphic ventricular arrhythmias in a healthy young athlete: a case report. Eur Heart J Case Rep 2024; 8:ytae012. [PMID: 38313322 PMCID: PMC10836886 DOI: 10.1093/ehjcr/ytae012] [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: 11/01/2023] [Revised: 12/27/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024]
Abstract
Background In young competitive athletes, ventricular arrhythmias could be a reason for concern as they may represent the sign of a serious underlying cardiac condition. On the other hand, atrial or conduction system premature beats are usually benign. However, when the properties of the His-Purkinje system lead to conduction aberrancies, there is a risk of misinterpreting benign arrhythmias as potentially at risk ventricular ectopic beats. Case summary We described the case of a healthy young athlete with asymptomatic interpolated junctional ectopic beats interpreted as polymorphic ventricular tachycardia during pre-participation screening. Discussion Strange and rare electrocardiogram pictures may be observed during sport pre-participation screening. The small atrioventricular (AV) junction is made up of many specialized fibres with different conduction properties. Junctional arrhythmias can have a normal anterograde conduction or can be conducted with aberrancy. Rarely, they can be interpolated and cause PR prolongation or bundle branch block by increasing the refractory period of the AV node and/or the conduction system. When aberrancy occurs, they can be mistaken for 'atypical' ventricular arrhythmias. Prognosis of these events remains uncertain.
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Affiliation(s)
- Nicolò Martini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | | | - 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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13
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Sharykin AS, Badtieva VA. Sudden Death In Sports: Modern Concepts. KARDIOLOGIIA 2024; 64:80-87. [PMID: 38323448 DOI: 10.18087/cardio.2024.1.n2617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/26/2023] [Indexed: 02/08/2024]
Abstract
Regular physical activity provides significant health benefits and reduces the risk of premature death from any cause, including cardiovascular diseases (CVD). However, physical activity may provoke sudden cardiac death (SCD), especially in presence of unrecognized diseases. It is essential to identify risk factors that contribute to SCD in athletes and to implement effective prevention of such episodes. For this purpose, SCD registries are being created, medical terminology is being unified, and schedules of medical examination are being developed. The best strategy to combat SCD during sport activities is a combination of primary prevention by screening examination to identify athletes with CVD at risk and a proper planning of first aid measures during sports events, including the availability of an automatic external defibrillator on site.
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Affiliation(s)
- A S Sharykin
- Moscow Center for Research and Practice in Medical Rehabilitation, Restorative and Sport Medicine; Pirogov Russian National Research Medical University
| | - V A Badtieva
- Moscow Center for Research and Practice in Medical Rehabilitation, Restorative and Sport Medicine; Sechenov First Moscow State Medical University
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14
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Corrado D, Zorzi A. Declining Risk of Sudden Cardiac Death in Young Athletes. Circulation 2024; 149:91-94. [PMID: 37955558 DOI: 10.1161/circulationaha.123.067243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Domenico Corrado
- Cardiomyopathy and Sports Cardiology Unit, Department of Cardiac Thoracic and Vascular Science and Public Health, University of Padova, Italy
| | - Alessandro Zorzi
- Cardiomyopathy and Sports Cardiology Unit, Department of Cardiac Thoracic and Vascular Science and Public Health, University of Padova, Italy
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15
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Mannarino S, Calcaterra V, Fini G, Foppiani A, Sanzo A, Pisarra M, Infante G, Marsilio M, Raso I, Santacesaria S, Zuccotti G. A pediatric telecardiology system that facilitates integration between hospital-based services and community-based primary care. Int J Med Inform 2024; 181:105298. [PMID: 37972482 DOI: 10.1016/j.ijmedinf.2023.105298] [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: 08/27/2023] [Revised: 10/25/2023] [Accepted: 11/12/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Telecardiology has emerged as a vital field within telemedicine, fostering collaboration between hospital and community medicine. This pilot study introduces an innovative pediatric telecardiology system, comprising a telecardiology system seamlessly integrated with a hospital telemedicine platform. A smooth flow of ECG execution, transmission, and reporting between Primary Care Pediatrician clinics and the hospital was tested as the primary objective. User experience surveys were also considered. METHODS The study involved three Primary Care Pediatrician clinics, and the enrollment of children took place consecutively from January to July 2023. We integrated a digital electrocardiographic signal acquisition unit and online information transmission-capable tablets, that were provided to the pediatricians, with a telemedicine multitenant platform that facilitated the transmission of the patient's ECG data from the community to the Hospital Pediatric Cardiologist. RESULTS A total of 158 children (80 M/78F, 8.9 ± 2.8 yrs) underwent ECG recording (78.5 % medical certificates, 21.5 % presence of symptoms) The transmission and reporting of ECGs were successfully completed in all cases, without technical issues. Normal findings on the ECG were demonstrated in 94.9 % of children. 70.8 % of respondents completed all parts of the survey. Respondents had a high level of education (90 %) and demonstrated excellent or good competence in using digital technologies (89 %). 51 % of respondents were not familiar with the term "Telemedicine" and 81 % of the cases had no previous telemedicine experience. 90 % of users were very satisfied or satisfied with the service. Connection problems (2.8 %) and concerns about the service's reliability compared to standard care (3.7 %) were mentioned as possible limitations of the telecardiology. CONCLUSIONS Our pediatric telecardiology system offers a valuable diagnostic tool to enhance patient management in the community.
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Affiliation(s)
- Savina Mannarino
- Pediatric Cardiology Unit, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy; Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy.
| | - Giulia Fini
- Pediatric Cardiology Unit, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Andrea Foppiani
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133 Milan, Italy; IRCCS Auxologico, Clinical Nutrition Unit, Department of Endocrine and Metabolic Diseases, Milan 20145, Italy
| | - Antonio Sanzo
- Arrhythmia and Electrophysiology Unit, Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Martina Pisarra
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, 20122 Milan, Italy
| | - Gabriele Infante
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, 20122 Milan, Italy
| | - Marta Marsilio
- Department of Economics, Management and Quantitative Methods (DEMM), Università degli Studi di Milano, 20122 Milan, Italy
| | - Irene Raso
- Pediatric Cardiology Unit, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Sara Santacesaria
- Pediatric Cardiology Unit, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Gianvincenzo Zuccotti
- Pediatric Department, Buzzi Children's Hospital, 20154 Milan, Italy; Department of Biomedical and Clinical Science, University of Milan, 20157 Milan, Italy
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16
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Orchard JJ, Orchard JW, Davis AJ, Puranik R, Isbister JC, La Gerche A, Driscoll T, Doughty RN, Hamilton B. Clinical outcomes of 10 years of cardiac screening in elite New Zealand athletes. J Sci Med Sport 2023; 26:659-666. [PMID: 37932202 DOI: 10.1016/j.jsams.2023.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To report findings from the High Performance Sport New Zealand cardiac screening programme, including comparisons between sexes and ethnicities. DESIGN Retrospective cohort study. METHODS Elite Olympic-sport athletes were screened (2012-2022) with personal/family history, physical examination, resting 12-lead ECG and followed from the date of first screening until July 2022. An audit reviewed screening records, including demographic data, ECGs, follow-up and diagnoses. Flagged/equivocal ECGs were re-reviewed (International Criteria). RESULTS 2075 ECGs from 1189 athletes (53 % female, mean age 21 years; 83 % European, 9 % Māori, 5 % Pacific Islander, 3 % other) were included. No athletes retired for cardiac reasons; there were no cardiac deaths or major cardiac incidents (mean follow-up from first screening: 6.1 years (range: 0.6-10.9 years)). Diagnoses included Wolff-Parkinson-White (WPW) syndrome (0.7 %) and cardiomyopathies (0.3 %). Overall, 3.5 % of ECGs were abnormal, with ECGs of females more commonly abnormal (4.4 % vs 2.5 %, p = 0.02) and with a higher proportion of ECGs with abnormal T-wave inversion (TWI) (3.1 % vs 0.9 %, p < 0.001) compared to males. Of the abnormal TWI in females (all aged ≥16 years), 47 % was limited to V1-V3 with no other abnormalities. Abnormality rates were similar between Māori, Pacific Islander and European athlete ECGs. CONCLUSIONS WPW was the most frequent diagnosis, with very little cardiomyopathy found. The proportion of abnormal ECGs was low overall, but higher in females. This was driven by anterior TWI in V1-V3 which was not associated with diagnoses of conditions associated with sudden cardiac death (SCD). There was no difference in the proportion of abnormal ECGs of Māori or Pacific Island athletes compared to European athletes.
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Affiliation(s)
- Jessica J Orchard
- Sydney School of Public Health, Faculty of Medicine & Health, The University of Sydney, Australia. https://twitter.com/jessicajorchard
| | - John W Orchard
- Sydney School of Public Health, Faculty of Medicine & Health, The University of Sydney, Australia. https://twitter.com/DrJohnOrchard
| | - Angus J Davis
- Sydney School of Public Health, Faculty of Medicine & Health, The University of Sydney, Australia. https://twitter.com/AngusDavis6
| | - Rajesh Puranik
- Faculty of Medicine & Health, The University of Sydney, Australia
| | - Julia C Isbister
- Sydney School of Public Health, Faculty of Medicine & Health, The University of Sydney, Australia. https://twitter.com/JuliaIsbister
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Australia; National Centre for Sports Cardiology, Australia. https://twitter.com/ALaGerche
| | - Tim Driscoll
- Sydney School of Public Health, Faculty of Medicine & Health, The University of Sydney, Australia
| | - Robert N Doughty
- University of Auckland, New Zealand; The Heart Group, New Zealand
| | - Bruce Hamilton
- High Performance Sport New Zealand, New Zealand; Sport Research Institute of New Zealand, Auckland University of Technology, New Zealand.
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17
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Idiazabal-Ayesa U, Ramírez-Vélez R, Sanz-de la Garza M, Izquierdo M. Electrocardiographic findings in pediatric versus young-adolescent athletes: A comparative analysis using general international criteria. Int J Cardiol 2023; 390:131201. [PMID: 37482093 DOI: 10.1016/j.ijcard.2023.131201] [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: 06/23/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The inclusion of electrocardiogram (ECG) in medical examinations for sports practice serves as a valuable tool for identifying potential life-threatening conditions during physical exercise. However, its applicability in young individuals remains a subject of controversy, primarily due to relatively high rates of false positives and the associated costs of further investigations. Furthermore, the validation of International Criteria for athletes below 12 years of age in optimizing pre-participation screening for young athletes is yet to be established. In light of these considerations, this study aims to describe the prevalence of ECG findings in a sample of children and young-adolescent athletes aged 11-16 years, employing refined Seattle interpretation criteria. Additionally, we seek to compare these findings based on age group and sex. METHODS This was a retrospective and observational study of 3747 athletes 11-16 year-olds. Evaluation included interviewer-administered questionnaires for relevant history, physical examination and resting 12 - lead ECG for each participant. The primary outcome measure was abnormal ECG findings according to the International Recommendations for Electrocardiographic Interpretation in Athletes. RESULTS Among the evaluated population of pediatric and young adolescent athletes (77.5% boys; >99% Caucasian), the vast majority exhibited normal electrocardiogram (ECG) results, with adaptive findings related to sports participation being more frequent among young adolescents and males. The presence of significant ECG abnormalities in young-adolescent athletes was uncommon (2.05%; 1.92% children and 2.32% young-adolescent) and required additional examinations. 0.27% of the total population were diagnosed with a previously unknown cardiac pathology only through the ECG. CONCLUSIONS This study provides valuable insights into the prevalence of normal, borderline, and abnormal electrocardiogram (ECG) findings in a large population of pediatric and young-adolescent athletes. These findings serve as guidance in detecting potentially serious cardiac alterations within this specific group, considering variations based on age and sex. The study confirms that ECG screening is a useful tool for identifying cardiac abnormalities in pediatric and young-adolescent athletes, even though the prevalence of significant findings in this population is relatively low. Furthermore, our findings support the utilization of the refined Seattle criteria as a sensitive and specific technique for screening pediatric and young-adolescent athletes, further enhancing the accuracy of ECG-based evaluations.
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Affiliation(s)
- Uxua Idiazabal-Ayesa
- Servicio de Cardiología y Medicina Interna, Hospital García Orcoyen, Estella, Navarra, Spain; Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - María Sanz-de la Garza
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
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18
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Abela M, Yamagata K, Bonello J, Xuereb S, Borg L, Xuereb R, Soler JF, Camilleri W, Abela E, Callus A, Farrugia M, Sapiano K, Felice T, Burg M, Sammut MA, Grech V, Papadakis M. BEAT-IT: A de-novo cardiac screening programme in Maltese adolescents. Hellenic J Cardiol 2023:S1109-9666(23)00183-5. [PMID: 37743018 DOI: 10.1016/j.hjc.2023.09.012] [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: 06/14/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023] Open
Abstract
AIMS Sudden cardiac death (SCD) in young individuals is often unexpected, provoking substantial emotional stress for family and friends of the deceased. Cardiac screening may identify individuals who harbour disorders linked to SCD. The feasibility and diagnostic yield of a nationwide cardiac screening programme in adolescents has never been explored. METHODS All individuals eligible for cardiac screening (students aged 15 years) were systematically invited to enrol. Students were provided with a health questionnaire. ECGs were acquired at school. A physician led consultation was carried out on site. Participants with an abnormal screen were then referred for secondary evaluation to the nation's tertiary centre. Feasibility criteria included a) participation rate >60%, b) adherence to secondary evaluation >80%, and c) cost per individual screened equating to <€100. The diagnostic yield was also evaluated. RESULTS At the end of enrolment, 2708 students gave consent (mean 15 years, 50.4% male), equating to 67.9% of the eligible cohort. Overall, 109 participants (4.0%) were referred for further evaluation. An abnormal electrocardiogram (ECG) was the most common reason for referral (3.7%). Fifteen individuals (0.6%) were diagnosed with a cardiac condition. Nine (0.3%) had a condition linked to SCD (n = 1 Long-QT syndrome, n = 1 Hypertrophic Cardiomyopathy, n = 5 Wolff-Parkinson White, n = 2 coronary anomalies). The yield was similar in athletes and non-athletes (p = 0.324). The cost per cardiac individual screened equated to €51.15. CONCLUSION A nationwide systematic cardiac screening programme for adolescent athletes and non-athletes is feasible and cost-efficient, provided that responsible centres have the appropriate infrastructure.
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Affiliation(s)
- Mark Abela
- Department of Cardiology, Mater Dei Hospital, Tal-Qroqq, Malta; Medical School, University of Malta, Malta; St George's, University of London, London, United Kingdom.
| | | | - John Bonello
- Department of Cardiology, Mater Dei Hospital, Tal-Qroqq, Malta
| | - Sara Xuereb
- Department of Cardiology, Mater Dei Hospital, Tal-Qroqq, Malta
| | - Lisa Borg
- Department of Cardiology, Mater Dei Hospital, Tal-Qroqq, Malta
| | - Rachel Xuereb
- Department of Cardiology, Mater Dei Hospital, Tal-Qroqq, Malta
| | | | | | - Estelle Abela
- Department of Cardiology, Mater Dei Hospital, Tal-Qroqq, Malta
| | - Adrian Callus
- Department of Cardiology, Mater Dei Hospital, Tal-Qroqq, Malta
| | - Maria Farrugia
- Department of Cardiology, Mater Dei Hospital, Tal-Qroqq, Malta
| | - Karl Sapiano
- Department of Cardiology, Mater Dei Hospital, Tal-Qroqq, Malta
| | - Tiziana Felice
- Department of Cardiology, Mater Dei Hospital, Tal-Qroqq, Malta
| | - Melanie Burg
- Department of Cardiology, Mater Dei Hospital, Tal-Qroqq, Malta
| | - Mark A Sammut
- Department of Cardiology, Mater Dei Hospital, Tal-Qroqq, Malta
| | - Victor Grech
- Medical School, University of Malta, Malta; Department of Paediatrics, Mater Dei Hospital, Tal-Qroqq, Malta
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19
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Corrado D, Trovato D, Zorzi A. Long QT Syndrome: A Preventable Cause of Exercise-Induced Sudden Cardiac Death. JACC Case Rep 2023; 22:101991. [PMID: 37790770 PMCID: PMC10544427 DOI: 10.1016/j.jaccas.2023.101991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Affiliation(s)
- Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
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20
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Fusco L, Sciarra L. What's new in sports cardiology? Hot topics from "Sport and Heart," First International Congress in Sports Cardiology. Clin Cardiol 2023; 46:1013-1014. [PMID: 37226865 PMCID: PMC10540009 DOI: 10.1002/clc.24034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/26/2023] Open
Affiliation(s)
- Liuba Fusco
- Cardiology DepartmentNew University Hospital NorthamptonNorthamptonUK
| | - Luigi Sciarra
- Department of Cardiovascular DiseasesUniversity of L'AquilaL'AquilaItaly
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21
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D'Ascenzi F, Ragazzoni GL, Boncompagni A, Cavigli L. Sports cardiology: A glorious past, a well-defined present, a bright future. Clin Cardiol 2023; 46:1015-1020. [PMID: 37503665 PMCID: PMC10540010 DOI: 10.1002/clc.24112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 07/29/2023] Open
Abstract
The attention towards sports cardiology has dramatically grown after the introduction of preparticipation screening and the need for specific education on electrocardiogram interpretation in athletes, given the differences between athletes and the general population. The present article stresses the need for specific skills, knowledge, and clinical expertise in sports cardiology, which are essential for appropriately screening competitive athletes to prevent sudden cardiac death and avoid overdiagnosis. However, disqualification from sports competitions may lead to sports inactivity, and athletes may enter a gray zone where little or no information is provided about what they can or cannot do to stay active. However, modern sports cardiology cannot neglect the patient's needs and the importance of the safe practice of regular exercise. In this context, the personalized exercise prescription plays a crucial role in the core curriculum and the clinical activity of professionals involved in sports cardiology programs. Given its specificities, sports cardiology requires a formal education plan for medical school students and all residents. Additional education and practice are required for young colleagues who want to focus their professional lives on sports cardiology. The future directions of emerging modern sports cardiology should not neglect the importance of a scientific community that works together, designing multicenter international outcomes-based research to address the many remaining areas of uncertainty.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
| | - Gian L. Ragazzoni
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
| | - Alex Boncompagni
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
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22
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Graziano F, Cipriani A, Balla D, Bondarev S, Marra MP, Bauce B, Vágó H, Corrado D, Zorzi A. Evolving spectrum of arrhythmogenic cardiomyopathy: Implications for Sports Cardiology. Clin Cardiol 2023; 46:1072-1081. [PMID: 37357443 PMCID: PMC10540004 DOI: 10.1002/clc.24069] [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: 05/03/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/27/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a genetic heart muscle disease, structurally characterized by progressive fibro-fatty replacement of the normal myocardium and clinically by ventricular arrhythmias (VAs). Predominantly thanks to the use of cardiac magnetic resonance, we have learnt that the spectrum of the disease encompasses not only the classical right ventricular phenotype, but also biventricular and left dominant variants. Sport activity contributes to the phenotypic expression and progression of ACM and may trigger life-threatening VAs and sudden cardiac death (SCD). We conducted a review of the literature about ACM and its implications in Sport Cardiology and summarized the main findings in this topic. Early identification of affected athletes through preparticipation screening (PPS) is fundamental but, while classical right-ventricular or biventricular phenotypes are usually suspected because of electrocardiogram (ECG) and echocardiographic abnormalities, variants with predominant left ventricular involvement are often characterized by normal ECG and unremarkable echocardiography. Usually the only manifestations of such variants are exercise-induced VAs and for this reason exercise testing may empower the diagnostic yield of the PPS. Patients with ACM are not eligible to competitive sports activity, but low-to-moderate intensity physical activity under medical supervision is possible in most cases.
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Affiliation(s)
- Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public HealthUniversity of PaduaPadovaItaly
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public HealthUniversity of PaduaPadovaItaly
| | - Dorottya Balla
- Department of Sports MedicineSemmelweis UniversityBudapestHungary
| | - Sergei Bondarev
- Department of Cardiac, Thoracic and Vascular Sciences and Public HealthUniversity of PaduaPadovaItaly
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public HealthUniversity of PaduaPadovaItaly
| | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences and Public HealthUniversity of PaduaPadovaItaly
| | - Hajnalka Vágó
- Department of Sports MedicineSemmelweis UniversityBudapestHungary
- Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public HealthUniversity of PaduaPadovaItaly
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public HealthUniversity of PaduaPadovaItaly
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23
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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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24
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Crea F. Challenges and opportunities in the management of acute heart failure and cardiac amyloidosis. Eur Heart J 2023; 44:2135-2139. [PMID: 37356037 DOI: 10.1093/eurheartj/ehad403] [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: 06/27/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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25
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de la Guía-Galipienso F, Ugedo-Alzaga K, Grazioli G, Quesada-Ocete FJ, Feliu-Rey E, Perez MV, Quesada-Dorador A, Sanchis-Gomar F. Arrhythmogenic Cardiomyopathy and Athletes - A Dangerous Relationship. Curr Probl Cardiol 2023:101799. [PMID: 37172878 DOI: 10.1016/j.cpcardiol.2023.101799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a disease characterized by a progressive replacement of myocardium by fibro-adipose material, predisposing to ventricular arrhythmias (VA) and sudden cardiac death (SCD). Its prevalence is estimated at 1:2000 to 1:5000, with a higher incidence in males, and clinical onset is usually between the 2nd and 4th decade of life. The prevalence of ACM in SCD victims is relatively high, making it one of the most common etiologies in young patients with SCD, especially if they are athletes. Cardiac events occur more frequently in individuals with ACM who participate in competitive sports and/or high-intensity training. In effect, exercise activity can worsen RV function in cases of hereditary ACM. Estimating the incidence of SCD caused by ACM in athletes remains challenging, being reported frequency ranging from 3-20%. Here, we review the potential implications of exercising on the clinical course of the classical genetic form of ACM, as well as the diagnostic tools, risk stratification, and the different therapeutic tools available for managing ACM.
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Affiliation(s)
- Fernando de la Guía-Galipienso
- From the Glorieta Policlinic, Denia, Alicante, Spain; REMA-Sports Cardiology Clinic, Denia, Alicante, Spain; Cardiology Service, Hospital HCB Benidorm, Alicante, Spain; School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain.
| | | | | | - Francisco Javier Quesada-Ocete
- School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain; Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Eloísa Feliu-Rey
- Magnetic Resonance Unit, Inscanner, General University Hospital of Alicante, Alicante, Spain
| | - Marco V Perez
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Aurelio Quesada-Dorador
- School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain; Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Fabian Sanchis-Gomar
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA..
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26
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Lim GB. Preparticipation screening reduces SCD in young athletes. Nat Rev Cardiol 2023; 20:212. [PMID: 36829084 DOI: 10.1038/s41569-023-00851-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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