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Catheter ablation in competitive athletes:
indication.
Furlanello F, Bertoldi A, Inama G, Fernando F.
Divisione di Cardiologia e Centro Aritmologico O.C.S. Chiara, Trento,
Italy.
Some supraventricular tachyarrhythmias (SVT), particularly if paroxysmal
and/or related to Wolff-Parkinson-White syndrome (WPW), may in some
cases endanger an athlete's professional career due to hemodynamic
consequences during athletic activity, which in some instances may be
life-threatening. One must also take into account that in Italy the law
makes antiarrhythmic drug treatment (AAD) incompatible with sport
eligibility. For these reasons, the utilization of radiofrequency
ablation (RFA) in athletes has different indications as opposed to the
normal population, since the primary goal is "the eligibility of
the athlete." In our study, we discuss the criteria for indication
of RFA in athletes with SVT on the basis of the data obtained from our
population of athletes, studied over a 20-year period, from 1974 to the
31st of December 1993. These athletes were evaluated for arrhythmic
events, utilizing a standardized cardioarrhythmological protocol: 1,325
athletes (1,125 men, 200 women, mean age 20.7 years). One subgroup
included 380 athletes with WPW (28.7%), 22 athletes with aborted sudden
death (1.6%), 6 of whom had WPW, 13 athletes with sudden death (0.98%),
and 2 of whom had WPW. Another subgroup was formed by 116 top level
elite professional athletes (TLA) (mean age 22.9 years), of which 10 of
116 (8.6%) had WPW and 12 of 116 (10.3%) had paroxysmal SVT. The most
important indications for RFA in athletes are represented by: WPW
asymptomatic at risk, symptomatic during athletic activity, and/or
requiring AAD treatment: paroxysmal junctional reentrant tachycardia:
when this condition is disabling and related to exercise and therefore
compromising an athlete's performance and sports career. Paroxysmal
junctional reentrant tachycardia is easily reproduced via
transesophageal atrial pacing (TAP) during exercise (bicycle ergometer),
common in athletes but normally the recurrences are concentrated only
during the period in which the athlete is engaged in sport. Rare
indications for RFA are focal or reentry, permanent SVT, and
particularly junctional reentrant tachycardia. For each individual
athlete, we have to consider the possible side-effects of RFA, the
possible recurrences with psychobiological traumatic consequences, the
effective recovery period, and the natural history of the
tachyarrhythmias, which frequently disappear after interruption of the
sports career.
PMID: 10159775 [PubMed - indexed for MEDLINE]
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| Cardiologia 1991 Aug;36(8 Suppl):117-20 |
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[Supraventricular reentry tachycardia and
athletic fitness]
[Article in Italian]
Furlanello F, Bertoldi A, Bettini R, Vergara G, Dallago M.
Divisione di Cardiologia, Ospedale S Chiara, Trento.
Paroxysmal supraventricular reciprocating tachycardias (PSRT) which
are due to a different type of reentry including the
atrioventricular reentry circuit of Wolff-Parkinson-White (WPW)
syndrome, may disturb the professional career of an athlete.
Moreover even severe episodes of preexcited atrial fibrillation of
WPW may occur. PSRT in athletes may present various clinical
consequences: unimportant symptoms, or severe hemodynamic effects on
the athletic performance particularly during sports activity at
intrinsic high risk. The athletes are evaluated by clinical protocol
which includes Holter monitoring ergometric test, echocardiography
study, thyroid check and transesophageal electrophysiologic study at
rest and during exercise. The arrhythmological study should be
carefully performed in order to exclude an underlying heart disease,
to study electrophysiological mechanisms and possible hemodynamic
effect sports activity relate of the inducible and clinical
tachyarrhythmias. Sometimes, these PSRT may disappear after
interruption of athletic activity because of modifications of
electrophysiological conditions related to the sports activity
Tachyarrhythmias in young athletes.
Coelho A, Palileo E, Ashley W, Swiryn S, Petropoulos AT, Welch WJ,
Bauernfeind RA.
Nineteen young athletes with documented symptomatic tachyarrhythmia were
systematically evaluated. There were 15 men and 4 women, aged 14 to 32
years (mean 22 +/- 6). Documented tachyarrhythmias were paroxysmal
atrial fibrillation in five patients, paroxysmal supraventricular
tachycardia in five, paroxysmal ventricular tachycardia in eight (sustained
in five, nonsustained in three) and ventricular fibrillation in one
patient. Abnormal substrates were demonstrated in 15 (79%) of the 19
athletes: 5 had an anomalous atrioventricular (AV) pathway and 10 had
heart disease (mitral valve prolapse in 9 patients and dilated
cardiomyopathy in 1 patient). In 13 (68%) of the 19 athletes, all
spontaneous attacks of tachyarrhythmia had started during strenuous
exercise. Tachyarrhythmia that closely resembled clinical arrhythmia was
induced by programmed cardiac stimulation in 13 athletes (68%) and was
reproducibly provoked by treadmill exercise in 8 athletes (42%). In four
of seven athletes with ventricular tachycardia, tachycardia closely
resembling clinical arrhythmia was provoked by infusion of isoproterenol.
In summary: young athletes can have any of several tachyarrhythmias;
abnormal substrates can be demonstrated in many athletes with
symptomatic tachyarrhythmia; and tachyarrhythmias in young athletes
frequently occur during exercise.
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