Significance of Electrocardiographic Right Bundle Branch Block in Trained Athletes

Kim, Jonathan H.; Noseworthy, Peter A.; McCarty, David; Yared, Kibar; Weiner, Rory B.; Wang, Francis; Wood, Malissa J.; Hutter, Adolph M.; Picard, Michael H.; Baggish, Aaron L.

doi:10.1016/j.amjcard.2010.11.037

Cited by 96 publications

(39 citation statements)

References 24 publications

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“…In contrast to earlier results, referring to this phenomenon as a result of right ventricular adaptation to exercise, IRBB was not more frequent in athletes compared to controls in our study (11). If IRBB is associated with other ECG abnormalities such as repolarization changes or clinical signs or symptoms, structural heart diseases such as ostium secundum atrial septal defect must be excluded.…”

Section: Discussioncontrasting

confidence: 54%

“…Athletes with this ECG abnormality must undergo a thorough cardiac examination towards structural diseases, since arrhythmogenic right ventricular cardiomyopathy (ARVC) or Brugada syndrome often manifest as CRBB (7). However, Kim et al found that increasing QRS duration and CRBB can be a result of more exercise training and right ventricular enlargement in healthy athletes (11). We found the presence of CRBB in a single athlete, detailed cardiac examination did not show any sign of structural heart disease.…”

Section: Discussionmentioning

confidence: 46%

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Prevalence of physiological and pathological electrocardiographic findings in Hungarian athletes

Kiss

Sydó

Vargha

et al. 2015

Acta Physiologica Hungarica

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In Hungary, ECG is a keystone of routine athletic screening. Its significance is based on simplicity, quickness and high informative value as well as the fact that appearance of pathological ECG signs can precede the formation of structural heart diseases. During screening of healthy athletes, we studied the incidence of athletic ECG changes and pathological ECG abnormalities. Methods: We performed detailed analysis of 12-lead ECG recordings of asymptomatic elite, non-elite and master athletes and controls. Results: 227 athletes (male: 180, age: 27.2±8.7 years) and 89 controls (male: 57, age: 28.1±6.8 years) were examined. Benign ECG signs: sinus bradycardia, early repolarization and isolated Voltage criteria of left ventricular hypertrophy were common and more often in athletes compared to controls. Potentially pathological ECG signs: ST-(6.6% vs. 1.1%, p < 0.05) and T-wave (15.0% vs. 5.6%, p < 0.05) changes and signs of pathological left ventricular hypertrophy (5.3% vs. 0%, p < 0.05) occurred more frequently in athletes compared to controls. Conclusions: Signs of pathological left ventricular hypertrophy and repolarization abnormalities are more often in athletes. No structural heart disease could be verified in the background of the disorders. However, athletes having pathological ECG should be kept under tight cardiology control. Exact definition and widespread knowledge of pathological ECG changes is essential in early recognition of high risk athletes.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 46%

Prevalence of physiological and pathological electrocardiographic findings in Hungarian athletes

Kiss

Sydó

Vargha

et al. 2015

Acta Physiologica Hungarica

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“…5,[9][10][11]24,26,27 Nonspecific ECG markers of pathology were also entered into analyses (left-and right-axis deviation, LV hypertrophy, RV hypertrophy, any TWI, and anterior TWI). Reproducibility of RV measurements was assessed with intraclass correlation coefficient analysis and reported as intraclass correlation coefficient (95% confidence interval [CI]).…”

Section: Discussionmentioning

confidence: 99%

“…24,25 Independent variables were selected on the basis of associations with LV or RV size in previous studies of athletes (age, sex, BSA, endurance sports, HD-HS sports, ethnicity, training intensity, LV end-diastolic diameter, LV mass index, pulmonary artery systolic pressure, and partial or complete right bundle-branch block). 5,[9][10][11]24,26,27 Nonspecific ECG markers of pathology were also entered into analyses (left-and right-axis deviation, LV hypertrophy, RV hypertrophy, any TWI, and anterior TWI). Reproducibility of RV measurements was assessed with intraclass correlation coefficient analysis and reported as intraclass correlation coefficient (95% confidence interval [CI]).…”

Section: Discussionmentioning

confidence: 99%

Physiological Right Ventricular Adaptation in Elite Athletes of African and Afro-Caribbean Origin

et al. 2013

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Background-Regular, intensive exercise results in physiological biventricular cardiac adaptation. Ethnicity is an established determinant of left ventricular remodeling; black athletes (BAs) exhibit more profound LV hypertrophy than white athletes (WAs). Right ventricular (RV) remodeling has not been characterized in BAs, although the issue is pertinent because BAs commonly exhibit ECG anomalies that resemble arrhythmogenic RV cardiomyopathy. Methods and Results-Between 2006 and 2012, 300 consecutive BAs (n=243 males) from 25 sporting disciplines were evaluated by use of ECG and echocardiography. Results were compared with 375 WAs and 153 sedentary control subjects (n=69 blacks). There were no ethnic differences between RV parameters in control subjects. Both BAs and WAs exhibited greater RV dimensions than control subjects. RV dimensions were marginally smaller in BAs than in WAs (proximal outflow tract, 30.9±5.5 versus 32.8±5.3 mm, P<0.001; longitudinal dimension, 86.6±9.5 versus 89.8±9.6 mm, P<0.001), although only 2.3% of variation was attributable to ethnicity. RV enlargement compatible with diagnostic criteria for arrhythmogenic RV cardiomyopathy was frequently observed (proximal outflow tract ≥32 mm; 45.0% of BAs, 58.5% of WAs). Anterior T-wave inversion was present in 14.3% of BAs versus 3.7% of WAs (P<0.001). Marked RV enlargement with concomitant anterior T-wave inversion was observed in 3.0% of BAs versus 0.3% of WAs (P=0.005). Further investigation did not diagnose arrhythmogenic RV cardiomyopathy in any athlete. Conclusions-Physiological RV enlargement is commonly observed in both black and white athletes. The impact of ethnicity is minimal, which obviates the need for race-specific RV reference values. However, in the context of frequent ECG repolarization anomalies in BAs, the potential for erroneous diagnosis of arrhythmogenic RV cardiomyopathy is considerably greater in this ethnic group. (Circulation. 2013;127:1783-1792.)Key Words: cardiomyopathy ◼ echocardiography ◼ electrocardiographic screening ◼ ethnicity ◼ exercise © 2013 American Heart Association, Inc.Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.112.000270Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz. Received December 6, 2012; accepted March 4, 2013. From St. George's University of London, London, United Kingdom (A.Z., S. Ghani, R.S., N.S., S. Gati, M.P., S.S.); University Hospital Lewisham, London, United Kingdom (A.Z., S. Ghani, N.S., S. Gati, S.S.); Liverpool John Moores University, Liverpool, United Kingdom (D.O.); and Imperial College Healthcare NHS Trust, London, United Kingdom (V.F.P. [WAs]). 10,11 The influence of ethnicity on athletic RV remodeling has never been characterized, even though healthy BAs frequently reveal ECG repolarization anomalies that resemble those observed in ARVC.12 Furthermore, BAs comprise a growing number of elite sports participants worldwide, and for reasons that remain incompletely under...

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“…Ambulatory monitoring and EPS can be used in a very selective fashion in patients with documentation of symptoms possibly attributable to progression to type II second-degree AV block or complete heart block. 4 Progression is more likely if left anterior fascicular block accompanies the RBBB. …”

Section: Complete Rbbbmentioning

confidence: 99%

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 9: Arrhythmias and Conduction Defects

Zipes¹,

Link²,

Ackerman³

et al. 2015

Circulation

122

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A broad range of variations in heart rates and rhythms, specific cardiac arrhythmias, and atrioventricular (AV) and intraventricular conduction disturbances are observed in athletes. Although most are common among nonathletes as well, the special circumstances and pressures related to athletic performance demand a high level of attention. The distinction between normal variants, often exaggerated by the specific physiology of the conditioned athlete, and arrhythmias that may be symptomatic or life-threatening may be significant challenges. Bradycardia Sinus BradycardiaSinus bradycardia, defined as a sinus rate <60 beats per minute (bpm), is common in the athlete.1 Generally, it is attributed to enhanced vagal tone caused by conditioning and is thus physiological. Occasionally, heart rates can be as slow as 30 to 40 bpm at rest in the highly conditioned athlete and decrease to <30 bpm during sleep. Some athletes with marked sinus bradycardia will exhibit periods of low atrial or junctional escape rhythms with rates of 40 to 60 bpm. This is a normal phenomenon, and these will become suppressed with exercise-induced increases in the sinus rate.Evaluation of the athlete with sinus bradycardia includes a careful history to determine whether the athlete has symptoms related to the bradycardia. In addition, physical examination and an ECG are warranted, with selective use of additional tests such as an echocardiogram and exercise stress test if underlying structural heart disease is suggested. Stress testing can also be used to verify a normal rate response to exercise, if judged to be necessary. The same approach applies to the sinus arrhythmia commonly observed in the athlete. Generally, asymptomatic sinus pauses or sinus arrest (<3 seconds) are not considered clinically significant unless accompanied by symptoms. Pauses of longer duration may fall within the spectrum of physiological responses to athletic conditioning; however, when accompanied by symptoms, sinus bradycardia, The American Heart Association and the American College of Cardiology make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.The Preamble and other Task Force reports for these proceedings are available online at http://circ.ahajournals.org (Circulation. 2015;132:e256-e261; e262-e266; e267-e272; e273-e280; e281-e291; e292-e297; e298-e302; e303-e309; e310-e314; e326-e329; e330-e333; e334-e338; e339-e342; e343-e345; and e346-e349).This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on June 24, 2015, and the American Heart Association Executive Committee on July 22, 2015, and by the American College of Cardiology Board of Trustees and Ex...

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Significance of Electrocardiographic Right Bundle Branch Block in Trained Athletes

Cited by 96 publications

References 24 publications

Prevalence of physiological and pathological electrocardiographic findings in Hungarian athletes

Prevalence of physiological and pathological electrocardiographic findings in Hungarian athletes

Physiological Right Ventricular Adaptation in Elite Athletes of African and Afro-Caribbean Origin

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 9: Arrhythmias and Conduction Defects

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