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Role of extensive diagnostic workup in young athletes and nonathletes with complex ventricular arrhythmias.

Abstract：

BACKGROUND:Ventricular arrhythmias (VAs) are the most common cause of death in athletes. The differences in the electroanatomic substrate in athletes and nonathletes with complex VA are unknown. OBJECTIVE:The purpose of this study was to compare the electroanatomic substrate of complex VA in athletes vs nonathletes. METHODS:The study prospectively enrolled young athletes and nonathletes with VA. Patients underwent 2-dimensional echocardiography, cardiac magnetic resonance (CMR) imaging, coronary angiography, 3-dimensional electroanatomic mapping (3D-EAM), and 3D-EAM-guided endomyocardial biopsy (EMB). Follow-up included 24-hour electrocardiographic Holter or implantable cardioverter-defibrillator/loop recorder interrogation for VA recurrence. RESULTS:Thirty-three patients were enrolled: 18 competitive athletes (56%) and 15 nonathletes (44%). Left ventricular and right ventricular (RV) findings by echocardiography and CMR did not show structural disease. Nine athletes (50%) were asymptomatic compared to 1 nonathlete (7%; P <.05). Unifocal origin of VA was reported in 14 athletes (93%) and 17 nonathletes (94%). Athletes showed a larger RV unipolar than bipolar scar (18 ± 17 cm2 vs 3 ± 3.8 cm2; P = .04). Diagnostic yield of EMB was 50% in athletes and 40% in nonathletes. Among athletes, the final diagnosis was myocarditis in 2, arrhythmogenic ventricular right cardiomyopathy in 1, and focal replacement fibrosis in 1. Among nonathletes, EMB revealed focal replacement fibrosis in 4 cases. At median follow-up of 18.7 months, Kaplan-Meier curves showed lower VA recurrence in detrained athletes than nonathletes (53% vs 6%; P = .02). CONCLUSION:This study showed the need for extensive diagnostic workup in apparently healthy young patients with complex VA in order to characterize concealed cardiomyopathies.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Narducci ML,Pelargonio G,La Rosa G,Inzani F,d'Amati G,Novelli V,Marano R,Perna F,Bencardino G,Pinnacchio G,Genuardi M,Cammarano M,Palmieri V,Zeppilli P,Crea F

doi

10.1016/j.hrthm.2019.08.022

subject

Has Abstract

pub_date

2020-02-01 00:00:00

pages

230-237

issue

2

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(19)30809-4

journal_volume

17

pub_type

杂志文章

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