How to evaluate premature ventricular beats in the athlete: critical review and proposal of a diagnostic algorithm

Corrado, Domenico; Drezner, Jonathan A.; D’Ascenzi, Flavio; Zorzi, Alessandro

doi:10.1136/bjsports-2018-100529

Cited by 96 publications

(116 citation statements)

References 67 publications

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“…12,13 Currently, anterior TWI is a major criterion for the diagnosis of AC. 14 [15][16][17][18] Calore et al compared the ECG pattern in 80 healthy athletes with anterior TWI with 95 patients affected by HCM and 58 patients by AC. 10 In this study, J-point elevation <1 mm in the anterior leads F I G U R E 1 Electrocardiogram of a 24-year-old female tennis player with T-wave inversion from V1 to V4 at the preparticipation evaluation.…”

Section: Anterior Twimentioning

confidence: 99%

Interpretation of T‐wave inversion in physiological and pathological conditions: Current state and future perspectives

D’Ascenzi

Anselmi

Adami

et al. 2020

Clinical Cardiology

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The presence of T-wave inversion (TWI) at 12-lead electrocardiogram (ECG) in competitive athletes is one of the major diagnostic challenges for sports physicians and consulting cardiologists. Indeed, while the presence of TWI may be associated with some benign conditions and it may be occasionally seen in healthy athletes presenting signs of cardiac remodeling, it may also represent an early sign of an underlying, concealed structural heart disease or life-threatening arrhythmogenic cardiomyopathies, which may be responsible for exercise-related sudden cardiac death (SCD). The interpretation of TWI in athletes is complex and the inherent implications for the clinical practice represent a conundrum for physicians. Accordingly, the detection of TWI should be viewed as a potential red flag on the ECG of young and apparently healthy athletes and warrants further investigations because it may represent the initial expression of cardiomyopathies that may not be evident until many years later and that may ultimately be associated with adverse outcomes. The aim of this review is, therefore, to report an update of the literature on TWI in athletes, with a specific focus on the interpretation and management.

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Section: Anterior Twimentioning

confidence: 99%

Interpretation of T‐wave inversion in physiological and pathological conditions: Current state and future perspectives

D’Ascenzi

Anselmi

Adami

et al. 2020

Clinical Cardiology

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“…PVBs with a LBBB/inferior axis (positive QRS in aVF and negative QRS in V1 and aVL) configuration were considered of ventricular outflow tract origin; PVBs with a QRS duration of 130 ms or less resembling a typical RBBB/left or right axis deviation were considered of fascicular origin. 11,12 PVBs with two or more morphologies that accounted for 10% or more of all PVBs were classified as multifocal.…”

Section: Ecg Stress Testing: Protocols and Evaluation Of Ventricular mentioning

confidence: 99%

“…This may be explained by the different mechanism of VA: enhanced automaticity of a myocardial focus, unrelated to a cardiac disease, may result in a very high number of PVBs, while VA associated with pathological myocardial substrates are characteristically more often complex and adrenergic-dependent. 12…”

Section: Work-up Of Exercise-induced Vamentioning

confidence: 99%

Screening young athletes for diseases at risk of sudden cardiac death: role of stress testing for ventricular arrhythmias

Zorzi

Vessella

Lazzari

et al. 2019

Eur J Prev Cardiolog

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Aims: The athletic preparticipation evaluation (PPE) protocol proposed by the European Society of Cardiology includes history, physical examination and resting electrocardiogram (ECG). The aim of this study was to assess the results of adding constant-load ECG stress testing (EST) to the protocol for the evaluation of ventricular arrhythmias (VA) inducibility. Methods: We evaluated a consecutive cohort of young athletes with history, physical examination, resting ECG and EST. Athletes with VA induced by EST underwent 24-hour 12-lead Holter monitoring and echocardiography. Cardiac magnetic resonance (CMR) was reserved for those with frequent, repetitive or exercise-worsened VA, and for athletes with echocardiographic abnormalities. Results: Of 10,985 athletes (median age 15 years, 66% males), 451 (4.1%) had an abnormal history, physical examination or resting ECG and 31 (0.28%) were diagnosed with a cardiac disease and were at risk of sudden cardiac death. Among the remaining 10,534 athletes, VA at EST occurred in 524 (5.0%) and a previously missed at-risk condition was identified in 23 (0.22%); the most common (N ¼ 10) was an echocardiographically silent non-ischaemic left-ventricular fibrosis evidenced by CMR. The addition of EST increased the diagnostic yield of PPE by 75% (from 0.28% to 0.49%) and decreased the positive predictive value by 20% (from 6.9% to 5.5%). During a 32 AE 21 months follow-up, no cardiac arrests occurred among either eligible athletes or non-eligible athletes with cardiovascular disease. Conclusions: The addition of exercise testing for the evaluation of VA inducibility to history, physical examination and ECG resulted in an increase of the diagnostic yield of PPE at the expense of an increase in false-positive findings.

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“…30 Důvodem k dalšímu pátrání po možném proarytmogenním substrátu jsou i komplexní formy KES. 31 Typická morfologie KES vycházející z výtokového traktu pravé komory je morfologie blokády levého Tawarova raménka (LBBB) s inferiorní osou a přechodovou zónou ve svodu V 3 či dále. Pokud jsou přítomny kmity R již ve svodech V 1 a přechodová zóna je ve svodech V 2 -V 3 , je původ KES nejspíše z výtokového traktu levé komory, viz obr.…”

Section: Komorové Extrasystolyunclassified

(Sports and cardiac arrhythmias)

Havránek¹

2020

Cor Vasa

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Téma poruchy srdečního rytmu a sport zahrnuje jak závažné poruchy rytmu asociované s náhlou srdeční smrtí, tak i arytmie méně rizikové, které se vyskytují u sportovců ve vyšší míře. Mezi příčiny vzniku vážné poruchy rytmu u sportovců patří hypertrofi cká kardiomyopatie, arytmogenní kardiomyopatie, dilatační kardiomyopatie, syndrom dlouhého intervalu QT, syndrom časné repolarizace a Wolffův-Parkinsonův-Whiteův (WPW) syndrom. Příčinou maligní arytmie mohou být i anomálie věnčitých tepen nebo myokarditidy. U sportujících jedinců je přítomno i vyšší riziko výskytu fi brilace síní. Problematickým tématem je přítomnost komorových extrasystol, která může být zcela nevýznamná, ale může reprezentovat i závažné srdeční onemocnění.

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How to evaluate premature ventricular beats in the athlete: critical review and proposal of a diagnostic algorithm

Cited by 96 publications

References 67 publications

Interpretation of T‐wave inversion in physiological and pathological conditions: Current state and future perspectives

Interpretation of T‐wave inversion in physiological and pathological conditions: Current state and future perspectives

Screening young athletes for diseases at risk of sudden cardiac death: role of stress testing for ventricular arrhythmias

(Sports and cardiac arrhythmias)

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