Third‐degree atrioventricular block in an athlete

Hernández‐Madrid, Antonio; Moro, Claudio; Huerta, E Marín; Rayo, I

doi:10.1111/j.1365-2796.1991.tb00362.x

Cited by 7 publications

(2 citation statements)

References 6 publications

(1 reference statement)

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“…To our knowledge, exercise‐induced CAVB has only been described previously in one patient with chronic bifascicular block (4) and another asymptomatic athlete (3). The patient described here, thus, appears to be the first documented case of exercise‐triggered myocardial ischaemia resulting in CAVB.…”

Section: Discussionmentioning

confidence: 95%

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Exercise-induced myocardial ischaemia complicated by paroxysmal complete atrioventricular block

Chu

et al. 2004

International Journal of Clinical Practice

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This study describes a case of exercise-induced myocardial ischaemia accompanied by complete atrioventricular block (CAVB). A 59-year-old man with major depression, treated with regular imipramine and lithium for 20 years, experienced syncope episodes during exercise. Exercise, testing initially, identified ST depression in the inferior leads, and later found CAVB resulting in syncope and seizure. The patient recovered completely after resuscitation. Myocardial ischaemic markers were negative, but 35% stenosis was detected in the distal left main coronary artery by angiography. The combined use of verapamil, nitrate and aspirin was treated as the possible coronary spasm. Repeat treadmill caused negative ischaemic study or exercise-induced arrhythmia, 7 days later. The pathophysiology of the very rare exercise-induced paroxysmal CAVB has been reviewed.Exercise-induced complete atrioventricular block (CAVB) in patients with normal resting electrocardiogram is rare (1-4). This study reports the clinical features of a 59-year-old male with recurrent syncope on exercise, caused by CAVB without conduction system abnormalities at rest. To our knowledge, this study is the first to describe a case of exercise-induced myocardial ischaemia resulting in paroxysmal CAVB as the initial presentation in a 59-year-old male. C A S E R E P O R TA 59-year-old male presented to our out-patient department, complaining of syncope that lasted for 5 min after exercise in the morning, on June 17, 2003. The man regularly took imipramine (112 mg per day) and lithium carbonate (600 mg per night) for major depression. Clinical examination was unremarkable. Resting ECG revealed sinus rhythm. The patient underwent a treadmill test immediately after presenting at our clinic. After 3 min of performing the stage 1 exercise test, the patient complained of chest discomfort with ST elevation in the inferior leads and V2 (Figure 1). The patient then suddenly collapsed and suffered a CAVBinduced seizure (Figure 2A). Subsequently taken ECG displayed persistently elevated ST in the inferior leads and V1 with reciprocal ST depression in V2 to V6 ( Figure 2B). Following 4-min emergent resuscitation, the patient recovered completely except for persisting sinus tachycardia (Figure 3). Sequential cardiac troponin-I and creatine kinase MB were normal. Other test results included elevated uric acid (12.4 mg/dl, normal range: 2.5-7.5 mg/dl) and cholesterol (219 mg/dl, normal limit: below 200 mg/dl). Blood levels of imipramine and lithium carbonate were both within normal limits. Chest X-ray, echocardiography and brain computer tomograph were all unremarkable. 1 h later, emergent coronary angiography indicated 35% stenosis in the distal left main coronary artery with TIMI 4 flow, and no obvious thrombus was demonstrated. However, the patient refused to perform ergonovine provocation for coronary artery or electrophysiological studies. Under the impression of coronary spasm, the patient was treated daily with aspirin (100 mg), verapamil SR (240 mg), isosorbide-5-m...

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Section: Discussionmentioning

confidence: 95%

“…Exercise‐induced complete atrioventricular block (CAVB) in patients with normal resting electrocardiogram is rare (1–4). This study reports the clinical features of a 59‐year‐old male with recurrent syncope on exercise, caused by CAVB without conduction system abnormalities at rest.…”

Section: Introductionmentioning

confidence: 99%

Exercise-induced myocardial ischaemia complicated by paroxysmal complete atrioventricular block

Chu

et al. 2004

International Journal of Clinical Practice

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Guidelines for Competitive Athletes with Arrhythmias

Al-Sheikh

Zipes

2000

Developments in Cardiovascular Medicine

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Outcomes among Athletes with Arrhythmias and Electrocardiographic Abnormalities: Implications for ECG Interpretation

McClaskey

Lee²,

Buch

2013

Sports Med

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Electrocardiographic (ECG) aberrations and arrhythmias occur frequently among athletes due to normal variants, subclinical cardiac disease or structural and electrical remodeling in response to training. It is unclear whether these changes are associated with adverse clinical outcomes over time among otherwise asymptomatic, healthy athletes. Consensus guidelines have been developed to guide the clinician regarding further management of these arrhythmias. The purpose of this review is to summarize prospective data regarding cardiovascular outcomes related to ECG changes among athletes and compare these findings with current guidelines. A review of the literature was conducted using the PubMed database (1966--present). Outcomes of interest included documented cardiac symptoms or events, such as episodes of cardiac or cerebral hypoperfusion, sudden death or prophylactic procedural interventions. Studies were included for analysis if they involved (1) athletes with documented, baseline arrhythmias and/or abnormal ECG variations; (2) a study design with longitudinal follow-up (designated as >1 month, to exclude short-term Holter studies); and (3) outcomes that include documented cardiac symptoms or events. A total of 33 studies met the above criteria, encompassing over 4,200 athletes, with follow-up ranging from 2 months to 14.6 years. There were few adverse outcomes among cases of sinus bradycardia >30 bpm, sinus pauses <3 s, first-degree atrioventricular (AV) block, second-degree type I AV block and incomplete right bundle branch block. Results among these studies are concordant with guidelines that recommend work-up in the setting of cardiac symptoms, history or physical examination indicative of cardiac disease, severe sinus bradycardia or AV block that does not resolve with exercise or hyperventilation. Outcomes among prospective studies also support guidelines that recommend further evaluation for repolarization abnormalities and supraventricular tachycardias, including atrial fibrillation, atrial flutter and Wolff-Parkinson-White syndrome. Ventricular arrhythmias in the setting of structural cardiac disease are associated with an increased risk of adverse events, including sudden cardiac death, and warrant special consideration with regards to sports eligibility. Findings in this review are limited by a lack of control groups, limited assessment of confounding factors (such as performance-enhancing drugs), and under-representation of women and certain ethnicities. Further prospective studies are needed to better characterize the long-term outcome of ECG abnormalities among athletes and provide evidence for ECG interpretation guidelines.

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Third‐degree atrioventricular block in an athlete

Abstract: There is a wide spectrum of changes in the resting electrocardiograms of athletes. We here present a case of third-degree atrioventricular block in an asymptomatic young athlete.

Cited by 7 publications

References 6 publications

Exercise-induced myocardial ischaemia complicated by paroxysmal complete atrioventricular block

Exercise-induced myocardial ischaemia complicated by paroxysmal complete atrioventricular block

Guidelines for Competitive Athletes with Arrhythmias

Outcomes among Athletes with Arrhythmias and Electrocardiographic Abnormalities: Implications for ECG Interpretation

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