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Noninvasive cardiac screening in young athletes with ventricular arrhythmias.

Steriotis AK, Nava A, Rigato I, Mazzotti E, Daliento L, Thiene G, Basso C, Corrado D, Bauce B - Am. J. Cardiol. (2012)

Bottom Line: Results of ECG were normal in most athletes (85%).Overall, 30% of athletes were judged to have potentially dangerous VAs.In conclusion, cardiac screening with noninvasive examinations remains a fundamental tool for the identification of a possible pathologic substrate and for the characterization of electrical instability.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. steriotis@hotmail.com

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The most frequent morphologies of PVCs in our cohort of athletes. The first 5 cases of PVCs were characterized by LBBB morphology with variable axis deviation, and the next 4 cases of PVCs were characterized by RBBB morphology with variable axis deviation.
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fig1: The most frequent morphologies of PVCs in our cohort of athletes. The first 5 cases of PVCs were characterized by LBBB morphology with variable axis deviation, and the next 4 cases of PVCs were characterized by RBBB morphology with variable axis deviation.

Mentions: Holter monitoring showed a mean number of PVCs of 4,700 per day. The number of PVCs ranged from 0 to 720 per day in 49 athletes (33.8%), from 720 to 5,000 per day in 46 (31.7%), from 5,000 to 10,000 per day in 29 (20%), and from 10,000 to 20,000 per day in 17 (11.7%) and was >20,000 per day in 4 (2.8%). In 26 subjects (18%), PVCs numbered <20 per day and were judged nonsignificant. Only single PVCs were detected in 83 athletes (57%), and in the remaining athletes, repetitive forms were also detected (43%). Single PVCs had in 98% of subjects wide coupling intervals (>400 ms, mean 506 ± 104 ms). Among the 119 athletes with significant numbers of PVCs, in 105 (88%), PVCs were monomorphic. The most frequent PVC morphologies were left bundle branch block (LBBB) with inferior axis deviation (IAD) in 59 subjects (50%), RBBB with left axis deviation (LAD) in 21 (18%), LBBB with LAD in 18 (15%), RBBB with right axis deviation in 14 (12%), LBBB with normal axis in 14 (12%), and RBBB with IAD in 8 (7%) (Figure 1). IAD was considered between +75° and +105° and LAD ≤−30°. A total of 44 athletes (30%) showed ventricular couplets (monomorphic in 32, polymorphic in 12), with a mean coupling interval of 457 ± 181 (<400 ms in 11 [24%]); in 5 subjects, ventricular couplets were frequent (>100 per day), and in 1 case, they were frequent and short coupled. Asymptomatic, nonsustained ventricular tachycardia (VT) was present in 31 athletes (21%). Of these, 27 showed brief VT (3 to 10 beats): 17 presented triplets (mean rate 138 beats/min) and 10 presented runs from 4 to 10 beats (mean rate 170 beats/min). In 4 athletes, VT episodes of >10 beats were observed. Most athletes (n = 22 [71%]) showed single runs of VT during the day. The mean ventricular rate of all VTs was 130 beats/min (mean R-R interval 461 ms): 4 VTs (13%) with rates >210 beat/min, 9 (33%) with rates of 150 to 210 beats/min, 11 (35%) with rates of 100 to 150 beats/min, and 7 (22.5%) with rates <100 beats/min. Moreover, 4 athletes presented short runs of polymorphic VT. Overall, 13 VTs (9%) were judged potentially dangerous on the basis of electrocardiographic characteristics (short R-R interval, multiple or long episodes, polymorphism, exercise induction) or the presence of an organic substrate.10–12


Noninvasive cardiac screening in young athletes with ventricular arrhythmias.

Steriotis AK, Nava A, Rigato I, Mazzotti E, Daliento L, Thiene G, Basso C, Corrado D, Bauce B - Am. J. Cardiol. (2012)

The most frequent morphologies of PVCs in our cohort of athletes. The first 5 cases of PVCs were characterized by LBBB morphology with variable axis deviation, and the next 4 cases of PVCs were characterized by RBBB morphology with variable axis deviation.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3569714&req=5

fig1: The most frequent morphologies of PVCs in our cohort of athletes. The first 5 cases of PVCs were characterized by LBBB morphology with variable axis deviation, and the next 4 cases of PVCs were characterized by RBBB morphology with variable axis deviation.
Mentions: Holter monitoring showed a mean number of PVCs of 4,700 per day. The number of PVCs ranged from 0 to 720 per day in 49 athletes (33.8%), from 720 to 5,000 per day in 46 (31.7%), from 5,000 to 10,000 per day in 29 (20%), and from 10,000 to 20,000 per day in 17 (11.7%) and was >20,000 per day in 4 (2.8%). In 26 subjects (18%), PVCs numbered <20 per day and were judged nonsignificant. Only single PVCs were detected in 83 athletes (57%), and in the remaining athletes, repetitive forms were also detected (43%). Single PVCs had in 98% of subjects wide coupling intervals (>400 ms, mean 506 ± 104 ms). Among the 119 athletes with significant numbers of PVCs, in 105 (88%), PVCs were monomorphic. The most frequent PVC morphologies were left bundle branch block (LBBB) with inferior axis deviation (IAD) in 59 subjects (50%), RBBB with left axis deviation (LAD) in 21 (18%), LBBB with LAD in 18 (15%), RBBB with right axis deviation in 14 (12%), LBBB with normal axis in 14 (12%), and RBBB with IAD in 8 (7%) (Figure 1). IAD was considered between +75° and +105° and LAD ≤−30°. A total of 44 athletes (30%) showed ventricular couplets (monomorphic in 32, polymorphic in 12), with a mean coupling interval of 457 ± 181 (<400 ms in 11 [24%]); in 5 subjects, ventricular couplets were frequent (>100 per day), and in 1 case, they were frequent and short coupled. Asymptomatic, nonsustained ventricular tachycardia (VT) was present in 31 athletes (21%). Of these, 27 showed brief VT (3 to 10 beats): 17 presented triplets (mean rate 138 beats/min) and 10 presented runs from 4 to 10 beats (mean rate 170 beats/min). In 4 athletes, VT episodes of >10 beats were observed. Most athletes (n = 22 [71%]) showed single runs of VT during the day. The mean ventricular rate of all VTs was 130 beats/min (mean R-R interval 461 ms): 4 VTs (13%) with rates >210 beat/min, 9 (33%) with rates of 150 to 210 beats/min, 11 (35%) with rates of 100 to 150 beats/min, and 7 (22.5%) with rates <100 beats/min. Moreover, 4 athletes presented short runs of polymorphic VT. Overall, 13 VTs (9%) were judged potentially dangerous on the basis of electrocardiographic characteristics (short R-R interval, multiple or long episodes, polymorphism, exercise induction) or the presence of an organic substrate.10–12

Bottom Line: Results of ECG were normal in most athletes (85%).Overall, 30% of athletes were judged to have potentially dangerous VAs.In conclusion, cardiac screening with noninvasive examinations remains a fundamental tool for the identification of a possible pathologic substrate and for the characterization of electrical instability.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. steriotis@hotmail.com

Show MeSH
Related in: MedlinePlus