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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; 21:e151-e252. [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
Youth and adult participation in sports continues to increase, and athletes may be diagnosed with potentially arrhythmogenic cardiac conditions. This international multidisciplinary document is intended to guide electrophysiologists, sports cardiologists, and associated health care team members in the diagnosis, treatment, and management of arrhythmic conditions in the athlete with the goal of facilitating return to sport and avoiding the harm caused by restriction. Expert, disease-specific risk assessment in the context of athlete symptoms and diagnoses is emphasized throughout the document. After appropriate risk assessment, management of arrhythmias geared toward return to play when possible is addressed. Other topics include shared decision-making and emergency action planning. The goal of this document is to provide evidence-based recommendations impacting all areas in the care of athletes with arrhythmic conditions. Areas in need of further study are also discussed.
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Affiliation(s)
- Rachel Lampert
- Yale University School of Medicine, New Haven, Connecticut
| | - Eugene H Chung
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Rajat Deo
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Joe Dolan
- University of Utah, Salt Lake City, Utah
| | | | - Belinda R Gray
- University of Sydney, Camperdown, New South Wales, Australia
| | | | | | | | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jack C Salerno
- University of Washington School of Medicine, Seattle, Washington
| | - Maully J Shah
- Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
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Woo CC. Recreational windsurfing-related acute injuries: a narrative review. Part 2: injury prevention and a proposal for a set of potential prevention strategies with a holistic approach. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2023; 67:159-174. [PMID: 37840584 PMCID: PMC10575326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Objective The purpose of this review was to identify existing prevention strategies for recreational windsurfing-related acute injuries and provide clinicians with a practical overview of current evidence supporting proposed potential prevention strategies. Methods A literature search was conducted through March 8, 2023, using relevant keywords with Boolean operators, such as "windsurfing" AND "injury prevention" and "windsurfing" AND "exercise interventions," from the PubMed and Google Scholar databases. Only peer-reviewed English-articles were included. Results Existing prevention strategies, right-of-way rules, a new proposed set of eight potential primary to tertiary prevention strategies for windsurfing-related acute injuries, and proposed definitions of injury prevention levels equivalent to Haddon's matrix were identified and tabled. Conclusions The proposed potential prevention strategies may facilitate clinicians in preventing recreational windsurfing-related acute injuries. Injury prevention for recreational windsurfing is under-researched. Future studies should focus on large prospective clinical trials evaluating the efficacy of prevention strategies for recreational windsurfing-related injuries.
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Cuenza L, Cheong AP, Yeo TJ. Improving electrocardiogram interpretation in Asian athletes: A call to action. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:225-227. [PMID: 38904518 DOI: 10.47102/annals-acadmedsg.2023110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Affiliation(s)
- Lucky Cuenza
- ManilaMed Sports and Exercise Medicine Centre, Manila, Philippines
- Cardinal Santos Medical Center Sports Medicine Institute: The MVP Clinic, Manila, Philippines
| | | | - Tee Joo Yeo
- Department of Cardiology, National University Heart Centre, Singapore
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Lim B, Lim B, Hamzah F, Lim AT, Ng CS, Tan B, Tong KL. Comparison of four electrocardiographic criteria for the detection of cardiac abnormalities in Singapore athletes. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:230-238. [PMID: 38904520 DOI: 10.47102/annals-acadmedsg.2022191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Introduction Sudden cardiac death in athletes is a rare occurrence, the most common cause being hypertrophic cardiomyopathy, which increases the risk of sustained ventricular tachycardia or ventricular fibrillation. Most of these young athletes are asymptomatic prior to the cardiac arrest. Several electrocardiogram criteria such as the European Society of Cardiology group 2 Criteria changes, Seattle Criteria, Refined Criteria, and most recently the 2017 International Criteria, have sought to improve the accuracy of identifying these at-risk athletes during pre-participation screening while minimising unnecessary investigations for the majority of athletes at low risk.We aimed to compare the above four criteria in our Singapore athlete population to identify which criterion performed the best in detecting cardiac abnormalities on echocardiography. Method Out of 1,515 athletes included in Changi General Hospital, Singapore registry between June 2007 and June 2014, the electrocardiograms of 270 athletes with further cardiac investigations were analysed. We compared the above four electrocardiographic criteria to evaluate which performed best for detecting cardiac abnormalities on echocardiography in our Southeast Asian athlete population. Results The European Society of Cardiology, Seattle, Refined and 2017 International Criteria had a sensitivity of 20%, 0%, 20% and 5%, respectively; a specificity of 64%, 93%, 84% and 97%, respectively; a positive predictive value of 4%, 0%, 9% and 11%, respectively; and a negative predictive value of 91%, 92%, 93% and 93%, respectively for detecting abnormalities on echocardiography. Conclusion The latest 2017 International Criteria performed the best as it had the highest specificity and positive predictive value, joint highest negative predictive value, and lowest false positive rate.
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Affiliation(s)
- Benji Lim
- Department of Cardiology, Changi General Hospital, Singapore
| | - Baoying Lim
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Fadzil Hamzah
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Ang Tee Lim
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Chung Sien Ng
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Benedict Tan
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Khim Leng Tong
- Department of Cardiology, Changi General Hospital, Singapore
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Bula K, Bisaga J, Feret B, Razik M, Rozpiątkowska B, Tometczak M, Mizia-Stec K. Electro- and echocardiographic features of left ventricle hypertrophy in patients with hypertrophic cardiomyopathy. Ann Noninvasive Electrocardiol 2022; 27:e12992. [PMID: 35855565 PMCID: PMC9484024 DOI: 10.1111/anec.12992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 11/28/2022] Open
Abstract
Background Standard 12‐lead electrocardiogram (ECG), next to medical history and physical examination, is a basic screening tool for hypertrophic cardiomyopathy in General practice. There are many electrocardiographic criteria of left ventricular hypertrophy, but their accuracy is usually weak in patients with systemic hypertension or aortic stenosis. Sensitivity of these criteria in patients with HCM has not been well described. Aim To assess the prevalence of electrocardiographic criteria for LVH in patients with HCM and their relationship with echocardiographic parameters. Material and methods A total of 49 patients with HCM (mean age 53.2 ± 15.4 years; men/women: 31/18) were enrolled to study. Eight electrocardiographic criteria for LVH were evaluated and correlated with echocardiographic parameters. Results The ECG features of LVH were found in 36 (73.5%) subjects. These patients had increased thickness of intraventricular septum (20.5 ± 4.7 vs. 17.3 ± 3.2 mm, p = .03), LVM (340.5 ± 104.8 vs. 264.0 ± 61.5 g; p = .02), and LVMI (178.9 ± 48.8 vs. 125.9 ± 22.5; p = .002). All of ECG criteria for LVH had low sensitivity (14.3%–40.8%) for LVH diagnosis confirmed by echocardiography. The most common positive criterion was Cornell Voltage (20 patients; 40.8%). A total of 41 (83.4%) patients had T‐wave inversion in limb and/or precordial leads. LVMI correlated positively with R‐wave amplitude in aVL (R = 0.34; p = .03), Gubner‐Ungerleider voltage (R = 0.4; p = .009), and Cornell Voltage (R = 0.31; p = .04). Conclusion ECG criteria for LVH are characterized by poor sensitivity in patients with HCM. Cornell Voltage and criteria based on limb leads correlate positively with LVMI.
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Affiliation(s)
- Karolina Bula
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesian Medical Centre, Katowice, Poland
| | - Joanna Bisaga
- Students' Scientific Club of First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesian Medical Centre, Katowice, Poland
| | - Bartłomiej Feret
- Students' Scientific Club of First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesian Medical Centre, Katowice, Poland
| | - Michał Razik
- Students' Scientific Club of First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesian Medical Centre, Katowice, Poland
| | - Barbara Rozpiątkowska
- Students' Scientific Club of First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesian Medical Centre, Katowice, Poland
| | - Mateusz Tometczak
- Students' Scientific Club of First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesian Medical Centre, Katowice, Poland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Upper Silesian Medical Centre, Katowice, Poland
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Achmad BF, Alim S, Kusumawati HI, Fitriawan AS, Kurniawan D, Kafil RF. Cardiovascular Disease Risk Profiles in Indonesian Athletes. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Notwithstanding how physical exercise lessens cardiovascular and all-cause mortality, young and active athletes might have cardiovascular risk factors or fundamental cardiovascular diseases (CVDs), putting them at increased risk for sudden cardiac death during times of strenuous exercise.
AIM: The study aimed to assess the cardiovascular risk profile possessed by Indonesian athletes.
METHODS: This research was a quantitative study using a cross-sectional design, involving 234 Indonesian athletes (163 men and 71 women) from three sports, including football, basketball, and swimming. Data were collected between December 2020 to March 2021 using the Jakarta Cardiovascular Risk Score instrument adapted from the Framingham risk score. Descriptive statistics were utilized to dissect data information for frequency distribution, percentage, mean, and standard deviation.
RESULTS: Most of the participants in this study had excessive weekly exercise duration (more than 255 minutes/week) (n=177 athletes, 75.64%). Twenty-one participants (8.97%) had a higher MAP more than normal, and 51 participants (21.79%) had overweight BMI. In addition, 142 participants (60.68%) had a cardiovascular genetic disease from their parents (family history) and most of the participants also were active smokers (n=150, 64.10%). Based on the Jakarta Cardiovascular Risk Score, the Indonesian athletes who participated in this study had a mean cardiovascular risk of -1.5 (SD= 3.088, min-max= (-7) – 6). Most of the participants had low cardiovascular risk (n= 193, 82.48%). However, some participants had moderate and high cardiovascular risk, 32 (13.67%) and 9 (3.85%), respectively.
CONCLUSION: Most of the participants had low cardiovascular risk, however some of the participants had moderate and high cardiovascular risk.
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