Paolo Manetti, Maria Concetta Vono, Brunello Cappelli, Paola Zilli, Loira Toncelli, Carlo Rostagno, Giorgio Galanti.
Istituto di Clinica Medica Generale e Cardiologia, Centro Regionale di Riferimento di Medicina dello Sport, University of Florence, Italy
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Arrhythmias can represent an early sign of cardiovascular disease, but
they can be detected even in healthy subjects as well. Aim of the study was to evaluate cardiac rhythm
disturbance in athletes to split disease from health. Two hundred and ten unselected athletes (mean age 29±17
years old, 44 female subjects) were tested in the Regional Reference Sport Medicine Center of Florence. All
athletes underwent a physical examination, ECG during IRI-test, echocardiogram, ECG-Holter 24h monitoring
with a training session and a stress test with bicycle-ergometer. All subjects were not symptomatic except 19
athletes (9%) who referred sporadic palpitations. ECG at rest and during step-test showed cardiac rhythm
disturbance in 65 athletes (31%). This arrhythmic group referred symptoms in 16 cases (25% of arrhythmic
subjects). Echocardiography showed changes of left ventricular cavity and wall thickening accepted as due
to training. Symmetric left ventricular hypertrophy was found in only 9 athletes (4%), in according to sport
practice. Mild degree of valve regurgitation was detected in 175 athletes (83%). Mild mitral valve prolapse
was found in 32 subjects (15%) that were symptomatic for palpitations in 11 cases (5%). ECG-Holter 24h monitoring
showed arrhythmias (>2/hour) in 88 subjects (42%). Fifty-eight athletes (66% of this arrhythmic group) presented
monofocal ventricular ectopic beats. A lower percentage of athletes (6% of arrhythmic group) showed complex
ventricular arrhythmias. Only 15% of athletes with ventricular arrhythmias were symptomatic for palpitations.
Singular ectopic supraventricular beats were detected in 39 no symptomatic subjects (44% of arrhythmic subjects),
while runs of SVPT were screened in 6 symptomatic subjects (7% of arrhythmic subjects). During stress test
arrhythmias were present at rest or during recovery but disappeared at peak exercise in 68 of 72 subjects (96%).
Four symptomatic athletes of them suffered from ventricular and supraventricular arrhythmia at peak exercise
as well. They submitted to necessary exams (electrophysiological study or blood pressure monitoring) that did
not show any higher risk connected with sport activity: they were therefore admitted to sport practice. In
conclusion, arrhythmia represents a common event in sportive population, as expression of a functional aspect.
Sometimes may be difficult to distinguish between health and disease. In our opinion, an accurate anamnesis,
the presence of symptoms, an echocardiogram and a maximal exercise test can represents useful tools to
exclude higher risk connected with sport activity.
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