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"Medicina Sportiva" No.14 - 2008 The 15-th Sports Medicine Balkan Congress
SPORTS CARDIOLOGY


THE ELECTROCARDIOGRAPHIC ABNORMALITIES IN HIGHLY TRAINED ATHLETES IN RELATION TO THE GENETIC STUDY RELATED TO CAUSES OF UNEXPECTED SUDDEN CARDIAC DEATH

Macarie C, Dermengiu D, Ioana Stoian, Ligia Barbarii, Ileana Tepes Piser, Ghioncel O, Carp  A, Stoian. I
Romania


Background: Electrocardiograms in elite endurance athletes shows sometimes bizarre patterns suggestive of inherited channelopathies and cardiomyopathies responsable for unexpected sudden cardiac death. Among other methods, genetic analyses are required for correct diagnosis.
Objective: To correlate 12-lead electrocardiographic patterns suggestive of inherited channelopathies and cardiomyopathies to specific genetic analyses.
Design: Prospective study (2004-2006) of screening 12-lead ECG tracings in standard position and higher intercostal spaces V1 to V3 precordial leads, performed in athletes and normal sedentary subjects aged match. Genetic analyses of subjects with ECG abnormalities suggesive of inherited channelopathies and cardiomyopathies. Setting: All cardiologic exams and electrocardiograms were performed at National Institute of Cardiovascular Diseases „Prof Dr CC Iliescu”(Bucharest,Romania).Genetic study were done at National Institute of Forensic Medicine ”Mina Minovici” (Bucharest,Romania). Participants: 347 elite endurance athletes (seniors190,juniors157), mean age of 20; 200 subjects mean age of 21, belonging to the control group of 505 normal sedentary population.
Results: Seniors. RSR’(V1 to V3) pattern, in 45, 5 of them with questionable Brugada signs.Tipically Brugada1 sign in one. 3 epsilon waves, arrhythmic right ventricular cardiomypathy MRI confirmed in one. ST-segment elevation myocardial injury like in V1 to V3 precordial leads in 34 athletes.Genetic analyses - no gene mutations. Juniors. 5 athletes with abnormal T waves (bifid, n=4; inverted>2 mm ,n=1) and prolonged QTc (0.48”- 0.56”) had mutations on KCN genes. 2 athletes with questionable Brugada signs had mutations on KCN and SCN5A genes respectevly.
Conclusion: Bizarre QRS, ST-T patterns suggestive of abnormal impulse conduction in the right ventricle, including the right outflow tract, associated in some cases to prolonged QTc interval were observed in highly trained endurance athletes.The genetic analyses, negative in most athletes, identified surprising mutations in SCN5A and KCN genes in some.






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