ARTICLE –
abstractArrhythmological
sudden death in athletes - electrophysiological assessment and
management Negru G Alina1,2, Ivanică Gabriel2, Sorca-Albișoru Lavinia2, Matei Raluca2, Petrescu Lucian1,2, Ionac Adina1,2, Negru Serban1, Șt. I. Drăgulescu1,2 1University of Medicine and Pharmacy Victor Babeș, Timișoara, Romania 2Institute of Cardiovascular Medicine Timișoara, Romania
Abstract
Background.
The assessment by electrophysiological study of sudden cardiac death
risk of pure arrhythmological origin in the athletes with positive
history of tachycardia was not previously described by the literature. Method
and results. A prospective study conducted between 2010 and 2014 which
included 62 patients, all athletes, performing category IIA sports or
higher according to Bethesda Classification of sports, with positive
history of arrhythmia (ECG documentation; syncope or aborted cardiac
arrest; suggestive symptoms). All patients were evaluated by non
invasive (ECG, effort testing) and invasive testing
(electrophysiological study). The radiofrequency ablation was done in
selected patients. The mean age of all patients was 17.62±6
years. There were found 29 patients (46.77%) with sudden cardiac death
risk, from which 15 patients (24.19%) had only symptoms, not previous
ECG documentation of arrhythmia and were discovered with high sudden
death risk at electrophysiological study. The most common types of
arrhythmia associated with sudden death risk were found to be the
Wolff-Parkinson-White syndrome, atrioventricular nodal reentrant
tachycardia and atrioventricular reciprocating orthodromic tachycardia
due to concealed accessory pathways, ventricular tachycardia and
premature ventricular contractions with degeneration into ventricular
tachycardia. Conclusions. The sudden death risk is much more
spread than thought among the athletes. This is due to cardiac
remodeling at one hand and to associated discrete pathologic conditions
on the other hand. Even if there is no documented tachycardia but the
symptoms are suggestive for arrhythmic events, further investigation by
effort testing and electrophysiological study in selected cases must be
done. The two mechanisms of death that we assessed in association with
the above described arrhythmias are degeneration into VF or hypo
diastolic shock with hemodynamic collapse due to very fast tachycardia.
In almost all cases, the radiofrequency ablation was the complete
curative method, permitting the continuation of sports.
Key
words:athletes, sudden cardiac death, supraventricular tachycardia, ventricular tachycardia, electrophysiological study, screening
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Arrhythmological sudden death in athletes - electrophysiological assessment and management
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