Background Some concerns exist about possible detrimental effects on cardiac function of ultra‐endurance competitions. The aim of this study was to evaluate the acute effects of an ultramarathon by comparing pre‐ and post‐race 12‐lead ECG features. Methods A total of 301 competitive athletes (mean age: 48 ± 9 years) running a 50‐km ultramarathon were analyzed. Twelve‐lead ECG was collected the day before the race and immediately at the finish line. According to the Italian law, athletes could have participated only after undergoing pre‐participation screening that ruled out the presence of an underlying heart disease. Results After the race a significant increase in P‐wave voltage (P < .001) and P‐wave duration (P < .001) was found as compared to pre‐race data with a higher percentage of athletes fulfilling the ECG criteria for right atrial enlargement (RAE; from 3% to 17%, P < .001). The presence of RAE post‐race significantly correlated with age, hours of training/week, and years of training and inversely with time at the finish line and the final position in the ranking. T‐wave and R‐wave amplitude (P < .001) and QTc‐interval duration (P < .001) significantly increased after the race. No significant differences in terms of supraventricular or ventricular arrhythmias were found. Conclusions A sizeable proportion of athletes running a 50‐km ultramarathon demonstrated post‐race ECG signs of right heart overload but no arrhythmias. This finding supports the hypothesis that ultra‐endurance races may induce transient right heart overload.
Aims Twelve-lead electrocardiogram (ECG) is an established tool in the evaluation of athletes, providing information about life-threatening cardiovascular diseases, such as long QT syndrome. However, the interpretation of ECG is sometimes challenging in children, particularly for the repolarization phase. The aim of this prospective, longitudinal study was to determinate the distribution of QT interval in children practicing sport and to evaluate changes in QT duration overtime. Methods and results A population of 1473 preadolescents practising sport (12.0 ± 1.8 years, 7–15 years) was analysed. Each athlete was evaluated at baseline, mid-term, and end of the study (mean follow-up: 3 ± 1 years). QT interval was corrected with Bazett (B) and Fridericia (F) formulae. At baseline QT interval corrected with the Bazett formula (QTcB) was 412 ± 25 ms and QT interval corrected with the Fridericia formula (QTcF) 387 ± 21 ms, with no changes during follow-up. Ten children (0.68%) had an abnormal QTc. In those with QTcB and QTcF ≥480 ms, QTc duration persisted abnormal during the follow-up and they were disqualified. Conversely, children with 460 ms < (QTcB) <480 ms had a normal QTc interval at the end of the study. These children had also a normal QTcF. Mean difference in the calculation of QT between the two formulae was 25 ± 11 ms (P < 0.0001). For resting heart rate (HR) ≥82 b.p.m., QTcF was independent from HR contrary to QTcB. Conclusion Normal QTc interval does not change over time in preadolescents. A minority of them has a QTc ≥480 ms; in these subjects, QTc interval remains prolonged. The use of Bazett and Fridericia correction formulae is not interchangeable and the Fridericia correction should be preferred in preadolescents with a resting HR ≥82 b.p.m.
Background Twelve-lead electrocardiogram (ECG) is an established tool in the evaluation of adult athletes, providing information about life-threatening cardiovascular diseases such as long-QT syndrome. However, changes induced by development challenge the interpretation of ECG in the paediatric population, particularly for the repolarisation phase. The aim of this prospective, longitudinal study was to determinate the distribution of QT interval in children practicing sport and to evaluate changes in QT duration during preadolescence. Methods A final population of 1473 children practising sport (mean age: 12.0±1.8 years, interval 7–15 years) was analysed. Each athlete was evaluated at baseline, mid-term and end of the study with a mean follow-up of 3±1 years. QT interval was corrected with Bazett (B) and Fridericia (F) formulae. Results At baseline QTcB was 412±25ms and QTcF 387±21ms, with no changes during follow-up. Ten children (0.68%) had an abnormal QTc. In children with QTc ≥480ms confirmed both by Bazett and Fridericia formulae, QT duration persisted abnormal during the follow-up and children were disqualified. Conversely, children with borderline QTc intervals (>460 and <480ms) were not disqualified and we found a normalization of QT interval during the development. Mean difference in the calculation of QT between the two formulae was 25±11ms, p<0.0001. For HR values higher than 80 bpm, the QTcF resulted with low fluctuations around the mean was independent from HR values. Conversely, the QTcB revealed significant growing trend as the HR increased and showed higher variability than Fridericia correction. Dynamic changes in QT interval duration Baseline Mid-term FU Long-term FU p value Intervallo QT 343±25 345±24* 346±25* <0.0001 RR (ms) 599±111 711±111* 721±119*^ <0.0001 QTc Bazett (ms) 412±25 (371–449) 411±25 (367–449) 409±25 (367–446) 0.10 QTc Fredericia (ms) 387±21 (355–418) 387±20 (353–419) 387±20 (353–418) 0.59 FU, follow up; *p<0.0001 vs. baseline; §p<0.0001 vs. mid-term FU; ^p<0.05 vs. mid-term FU. Conclusions QT duration does not change over time in children with normal duration. A minority of children has a QT ≥480ms; in these subjects QT interval remains prolonged during the follow-up. Conversely, in children with borderline QT, mid-term follow-up is useful to identify a normalization during the growth. Clinicians should take into account that the use of Bazett and Fridericia correction formulae is not interchangeable and that Fridericia formula should be preferred when resting HR is higher than 80 bpm.
Background Ultra-endurance competitions are becoming increasingly popular but the consequences of ultra-endurance sports activity on the heart rhythm is still a debated issue. Some authors demonstrated that athletes engaging in ultra-endurance sports show a transient rise in cardiac biomarkers and right ventricular dysfunction after a competition, suggesting the possibility of an adverse arrhythmic remodeling and an increased risk of sudden cardiac death. The aim of our study was to evaluate the effects on heart rhythm of an ultraendurance high-altitude race. Methods The study was performed during the 2018 North Face® Lavaredo Ultra Trail mountain run. We recorded the ECG with the FDA-approved MyDiagnostick device. Recordings were performed at baseline the day before the run and immediately after the run in the available athletes. The ECG was analyzed for heart rate, QRS duration, QT interval duration corrected according to the Bazett formula and presence of at least one beat of presumed ventricular origin (PVB). Results A total of 545 athletes (83% males, mean age: 40±9 years), 241 running the 120 Km race and 304 running the 50 Km race, were included in the study. At baseline, athletes showed a mean heart rate of 64±14 bpm and a mean QRS duration of 92±18 ms. Three (0.5%) showed at least one PVB. Analysis of QTc interval duration showed a mean value of 412±25 ms. After the race, athletes showed a higher heart rate (91±13 bpm, p<0.001), a similar QRS duration (94±16 ms, p=0.32) and a longer QTc interval duration (447±25 ms, p<0.001), as compared to baseline data. The number of athletes showing at least 1 PVB significantly increased to 18 (3.3%, p=0.004) as compared to pre-race evaluation. Athletes engaged in the 120 Km run showed a slightly longer post-run QTc interval (450±24 versus 444±25 ms, p=0.009) while the post-run QRS duration was similar between the two groups. The presence of PVBs after the race was not correlated with the duration of QTc interval. Conclusions In this study we found an increased number of PVBs and a prolonged QTc duration after an ultra-endurance competition. Increased ventricular ectopic activity and QT prolongation recorded shortly after an intense and prolonged exercise could contribute to the increased risk of arrhythmias occurring after the finish line.
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