RT-218
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Ventricular arrhythmias in
athletes: markers of subclinical heart disease
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Alessandro Biffi, Luisa Verdile,
Giovanni Caselli, Fernando Maria Di Paolo, Fredrick Fernando, Antonio Spataro, Antonio
Pelliccia, Paolo Di Renzi**, Gerardo Ansalone*, Fabrizio Ammirati*, Claudio Pandozi*,
Massimo Santini*.
Department of Medicine, Institute of Sports Science, CONI, *Department of Heart Disease,
San Filippo Neri Hospital, **Department of Radiology, Fatebenefratelli-Isola Tiberina
Hospital, Rome, Italy
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Abstract
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Background. In athletes, subclinical
cardiomyopathies can present as sudden death, particularly during exercise and
competititve sports. Therefore, early identification of myocardial disease in athletes
with ventricular arrhythmias is the main point of a preparticipation cardiovascular
screening.
Methods. Seventy athletes (Group A: mean age 24.5 ys, 48 males and 22
females) with ventricular arrhythmias (inclusion Holter monitoring criteria: > 2000
ventricular ectopic beats-VEB/24 h and > 15 couplets) and 70 control athletes (Group B:
mean age 23.8 ys, 48 males and 22 females) without arrhythmias underwent a cardiovascular
screening including physical examination, routine blood test, chest X-rays, resting and
stress test electrocardiogram (ECG), color-doppler echocardiogram, 24 hour Holter ECG
monitoring and time-domain signal-averaged ECG. Furthermore, 26 athletes of Group A
underwent a magnetic resonance imaging (MRI), 19 a cardionuclear scintigraphy, 9 a
transesophageal echocardiography, 4 a myocardial biopsy and 18 an electrophysiologic
study.
Results. Twenty-seven arrhythmic athletes of Group A showed a cardiac
anomaly (38.6%), versus 1/70 (1.4%) control athletes of group B (p < 0.0001). In
particular, 9 abnormal dilatation of the left ventricle, 8 mitral valve prolapse, 4 rigth
ventricular arrhythmogenic dysplasia, 4 myocarditis, 1 atrial septum defect and 1 bicuspid
aortic valve were found. Ventricular late potentials was recorded in 31/70 athletes of
Group A (44.3%), versus 3/70 athletes of Group B (4.3%) (p < 0.0001). In particular,
late potentials were found in 17/27 arrhythmic athletes with heart disease (63%) versus
10/43 arrhythmic athletes without cardiopathy (23.3%) (p < 0.002).
Conclusions. This study shows the usefulness of an extensive
cardiovascular preparticipation screening in identifying subclinical heart disease in
athletes with frequent and complex ventricular arrhythmias. The recording of ventricular
late potentials has been shown to be a very specific marker for the presence of an
underlying myocardial pathologic process.
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Key Words
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Arrhythmias in athletes
ventricular arrhythmias, subclinical heart disease, frequent/complex arrhythmias,
cardiovascular preparticipation screening, late potentials, myocardial biopsy,
echocardiography, magnetic resonance imaging, OA
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