[Stable ventricular tachycardia in arrhythmogenic dysplasia of the right ventricle in sportsmen]. / Stabil'naia zheludochkovaia takhikardiia pri aritmogennoi displazii pravogo zheludochka u sportsmenov.

Right ventricular arrhythmogenic dysplasia (RVAD) is a typical asymptomatic arrhythmogenic cardiopathy in athletes, which is occasionally concurrent with normal ventricular function and life-threatening arrhythmias. A total of 32 athletes (28 males and 4 females, mean age, 23 years, mean follow-up, 6.7 years) were examined for severe cardiac arrhythmias with left bundle branch block. The conclusive diagnosis of RVAD was established from clinical, echocardio-, and angiographic evidence. The protocol of the examination involved Holter monitoring, loading tests, electrophysiological study, two-dimensional echocardiography, cardiac angiography of the right and left ventricles, coronary angiography. The most severe arrhythmias were observed in athletes whose mean age was 23.4 years, 20 patients had sustained ventricular tachycardia (it occurred only in 19 who were indulging in sports), 6 presented with transient ventricular tachycardia, and 1 had ventricular fibrillation. They all had been considered fit for sports. The disease proceeded severely in 16 of 32 athletes (in 13 of 16 while indulging in sports), the conditions close to syncope were seen in 9 patients (8 had sustained ventricular tachycardias and 1 had transient ventricular tachycardias), syncopes were observed in 5 patients (sustained ventricular tachycardias).

[Cardiac rhythm in athletes: a Holter study of top level and ex-professional football players]. / Ritmo cardiaco nell'atleta: studio con Holter in calciatori "top level" ed ex calciatori professionisti.

The study we performed aimed at identifying the arrhythmological pattern in the football player. Between 1984 and 1989, 50 top level football players (group A) from the National Olympic team and from the National A team, average age 24.2 years (min. 19, max. 32), underwent Holter monitoring. The recordings were carried out in different environmental conditions according tot he programmes of the team and the number of recordings depended on how long each football player stayed in the National team. Moreover, 40 trainers (group B) from the Italian football teams, average age 38.4 years (min. 32, max. 57), all of whom had formerly been professional high-level football players practising intensive physical exercise for professional reasons, underwent one 24 h Holter monitoring. RESULTS. Group A: 2621 hours of monitoring were able to be analysed in 48/50 football players. Sinus node pauses greater than or equal to 1750 ms were found in 21/48 (43.7%) with a maximum of 3740 ms on altitude in 1/21, second degree atrioventricular block in 8/48 (16.7%) with a maximum of 5400 ms on altitude in 1/8, supraventricular ectopic beats in 13/48 (27%), ventricular ectopic beats in 26/48 (54.1%) which were complex (cl. Lown greater than or equal to 3) in 7/26. Group B: 882.30 hours of monitoring were able to be analysed in 39/40 former football players. Sinus node pauses greater than or equal to 1750 ms were found in 18/39 (46.1%) with a maximum of 2280 ms in 7/18, second degree atrioventricular block in 1/39 (2.6%) with a maximum of 2400 ms, supraventricular ectopic beats in 32/39 (82%), ventricular ectopic beats in 24/39 (61.5%) which were complex in 5/24.(ABSTRACT TRUNCATED AT 250 WORDS)

[Electrophysiologic evaluation of athletes with Wolff-Parkinson-White syndrome: induction of supraventricular arrhythmia at rest and under exertion with transesophageal atrial electrostimulation]. / La valutazione elettrofisiologica degli atleti con Wolff-Parkinson-White: induzione di tachiaritmia sopraventricolare di base e sotto sforzo con elettrostimolazione atriale transesofagea.

The most suitable approach to the athletes with WPW is controversial. Therefore 66 symptom-free athletes with WPW and without heart disease (53 M, 13 F, mean age 21.98 yrs, min 12--max 44) underwent a study protocol whose end-point was the induction of supraventricular tachyarrhythmia, i.e. atrial fibrillation or, if not possible, atrial flutter or atrial tachycardia at rest and during ergometric stress test. The athletes with shortest R-R interval between preexcited beats less than or equal to 240 ms at rest and/or less than or equal to 210 ms during exercise were judged as being at risk i.e. no fit for sport activity. The end-point was reached in 64/66 athletes (in 62 atrial fibrillation). In 4 athletes with life threatening arrhythmia induced at rest the evaluation during exercise was not performed. According to the evaluation at rest we were able to identify only 18 athletes (28.1%) as being at risk, while according to the complete study protocol 26 athletes (40.6%) were judged as such. In 23/64 athletes (36%) this judgement was discordant with the usual non invasive evaluation (i.e. Holter monitoring, ergometric stress test, ajmaline test). During induced atrial fibrillation no significant difference, was found between the percentage of preexcited beats at rest and during exercise. On the average, 40 min. are required for performance of this study protocol (if the induced arrhythmia lasts less than 5 min.). According to our results we conclude: a) the non invasive assessment of the WPW athletes is unsatisfactory; b) the induction of atrial fibrillation during exercise gives a remarkable increase of the diagnostic power with respect to the assessment only at rest; c) since it is simple to perform and not expensive (in time, staff and cost) and because of its high diagnostic yield, we regard this protocol as fundamental for the electrophysiological evaluation of WPW athletes and also suitable for systematic study of WPW patients.

Arrhythmia patterns in athletes with arrhythmogenic right ventricular dysplasia.

Arrhythmogenic right ventricular dysplasia (ARVD) is a typical 'silent' arrhythmogenic cardiomyopathy in athletes, with the possibility of normal ventricular performance and life-threatening arrhythmias. We studied 32 athletes (28 M, 4 F), mean age 23 years, follow-up 6.7 years, all previously declared fit for sports activity. They were studied for significant ventricular arrhythmias with LBBB with a final diagnosis of ARVD based on accepted clinical, echocardiographic and angiographic criteria. The study protocol included Holter monitoring (HM), stress test (ST), electrophysiological endocavitary study (EES), 2D echocardiography, RV and LV cardioangiography and coronarography. The most serious arrhythmia appeared at a mean age of 23.4 years, 20 had clinical sustained ventricular tachycardia (VT) (19/20, 95% during sports activity), six non-sustained VT and one ventricular fibrillation (VF). Severe symptoms occurred in 16/32 athletes (50%) during sports activity in 13/16 (81%): presyncope in nine (non-sustained VT in one, sustained VT in eight); syncope in five (sustained VT); aborted sudden death (SD) in one, SD (follow-up) in one. The reproducibility (HM, ST, EES) of clinically severe arrhythmic manifestations which occurred during sports activity was not high. In fact, during sport many factors are at work which may activate several arrhythmogenic mechanisms not easily reproducible in the laboratory. We conclude that a cardioarrhythmological study is mandatory in suspected right ventricular arrhythmias, including morphological study of the RV, to avoid arrhythmic risk during athletic activity.

[Arrhythmologic study of 50 patients with arrhythmogenic disease of the right ventricle: prognostic implications]. / Studio aritmologico in 50 pazienti con malattia aritmogena del ventricolo destro: implicazioni prognostiche.

UNLABELLED: Arrhythmogenic right ventricular disease is a syndrome which involves a wide spectrum of anatomo-clinical features. It is characterised by different levels of right ventricle anomaly, and by life-threatening "right" hyperkinetic ventricular arrhythmias. Fifty consecutive pts were retrospectively examined at the Arrhythmological Centre in Trento between 1977 and 1988. The results of rigorous arrhythmological, echocardiographic and angiographic criteria showed that all pts were affected by arrhythmogenic right ventricular disease. CASE STUDY: 39/50 (78%) males, 11/50 (22%) females; age 30.6 years (11-78) at the time of the first study. METHODS: clinical history in 50/50 pts, electrocardiogram in 50/50 pts, Holter monitoring in 50/50 pts, ergometric test in 49/50 pts, non-invasive analysis using signal-averaging QRS in 17/50 pts, 2D echocardiogram in 50/50 pts, angiography in 38/50 pts, electrophysiological endocavitary study in 35/50 pts. RESULTS: familial 2/50 (4%); 1/50 (2%) was in class II NYHA; first arrhythmia at 24.6 years (8-60); most severe arrhythmia at 27.7 years (9-74). Forty-three out of fifty patients (86%) were symptomatic for arrhythmias: 28/50 (56%) as a result of stress; 20/50 (40%) had life-threatening symptoms; 6/50 (12%) had aborted sudden death. Arrhythmogenic right ventricular disease was "localized" in 42/50 (84%) and "diffused" in 8/50 (16%) and was associated with anomalies of the left ventricle in 30/50 (60%). Electrocardiogram showed: right bundle branch block in 10/50 (20%), negative T wave on the right precordial leads in 19/50 (38%), delayed ventricular potentials in 4/17 (23.5%). Using the electrocardiogram, Holter monitoring and electrophysiological endocavitary study the following were documented: a) clinical ventricular tachycardia in 40/50 (80%): non-sustained ventricular tachycardia in 10/50 (20%), sustained ventricular tachycardia in 30/50 (60%); b) electrically induced ventricular tachycardia in 26/35 (74.2%): non-sustained ventricular tachycardia in 8/35 (22.8%), sustained ventricular tachycardia in 18/35 (51.4%) (clinical sustained ventricular tachycardia in 18/18); c) multiform ventricular tachycardia in 12/50 (24%) (diffused arrhythmogenic right ventricular disease in 3/12 and associated anomalies of the left ventricle in 11/12); d) pleomorphic sustained ventricular tachycardia in 9/30 (30%) (diffused arrhythmogenic right ventricular disease in 2/9, and associated anomalies of the left ventricle in 8/9). Forty-two out of fifty patients (84%) underwent antiarrhythmic treatment. When the study was carried out 6.6 years (1 month-22 years) had passed since the first symptom; follow-up was 2.1 years (1 month-11 years) while the interval between the first symptom and the last check-up was 8.4 years (1-30 years); 2/50 dropped out and 2/50 died suddenly.(ABSTRACT TRUNCATED AT 400 WORDS)