TY - JOUR
T1 - Ventricular arrhythmias in athletes
T2 - Role of a comprehensive diagnostic workup
AU - Dello Russo, Antonio
AU - Compagnucci, Paolo
AU - Casella, Michela
AU - Gasperetti, Alessio
AU - Riva, Stefania
AU - Dessanai, Maria Antonietta
AU - Pizzamiglio, Francesca
AU - Catto, Valentina
AU - Guerra, Federico
AU - Stronati, Giulia
AU - Andreini, Daniele
AU - Pontone, Gianluca
AU - Bonomi, Alice
AU - Rizzo, Stefania
AU - Di Biase, Luigi
AU - Capucci, Alessandro
AU - Natale, Andrea
AU - Basso, Cristina
AU - Fiorentini, Cesare
AU - Zeppilli, Paolo
AU - Tondo, Claudio
N1 - Funding Information:
Funding Sources: The authors have no funding sources to disclose. Disclosures: Dr Dello Russo is a consultant for Abbott. Dr Di Biase is a consultant for Biosense Webster, Boston Scientific, and Abbott; and has received modest honoraria from Medtronic, AtriCure, and EPiEP. Dr Natale is a consultant for Boston Scientific, Biosense Webster, Abbott, Biotronik, Medtronic, and Biotronik. Dr Tondo received modest honoraria from Abbott; and serves as member of the advisory board for Medtronic, Inc., and Boston Scientific Corp. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2021 Heart Rhythm Society
PY - 2022/1
Y1 - 2022/1
N2 - Background: Ventricular arrhythmias (VAs) represent a critical issue with regard to sports eligibility assessment in athletes. The ideal diagnostic evaluation of competitive and leisure-time athletes with complex VAs has not been clearly defined. Objective: The purpose of this study was to assess the clinical implications of invasive electrophysiological assessments and endomyocardial biopsy (EMB) among athletes with VAs. Methods: We evaluated 227 consecutive athletes who presented to our institutions after being disqualified from participating in sports because of VAs. After noninvasive tests, electrophysiological study (EPS), electroanatomic mapping (EAM), and EAM- or cardiac magnetic resonance imaging–guided EMB was performed, following a prespecified protocol. Sports eligibility status was redefined at 6-month follow-up. Results: From our sample, 188 athletes (82.8%) underwent EAM and EPS, and 42 (15.2%) underwent EMB. A diagnosis of heart disease could be formulated in 30% of the study population (67/227; 95% confidence interval [CI] 0.24–0.36) after noninvasive tests; in 37% (83/227; 95% CI 31%–43%) after EPS and EAM; and in 45% (102/227; 95% CI 39%–51%) after EMB. In the subset of athletes undergoing EMB, invasive diagnostic workup allowed diagnostic reclassification of half of the athletes (n = 21 [50%]). Reclassification was particularly common among subjects without definitive findings after noninvasive evaluation (n = 23; 87% reclassified). History of syncope, abnormal echocardiogram, presence of late gadolinium enhancement, and abnormal EAM were linked to sports ineligibility at 6-month follow-up. Conclusion: A comprehensive invasive workup provided additional diagnostic elements and could improve the sports eligibility assessment of athletes presenting with VAs. The extensive invasive evaluation presented could be especially helpful when noninvasive tests show unclear findings.
AB - Background: Ventricular arrhythmias (VAs) represent a critical issue with regard to sports eligibility assessment in athletes. The ideal diagnostic evaluation of competitive and leisure-time athletes with complex VAs has not been clearly defined. Objective: The purpose of this study was to assess the clinical implications of invasive electrophysiological assessments and endomyocardial biopsy (EMB) among athletes with VAs. Methods: We evaluated 227 consecutive athletes who presented to our institutions after being disqualified from participating in sports because of VAs. After noninvasive tests, electrophysiological study (EPS), electroanatomic mapping (EAM), and EAM- or cardiac magnetic resonance imaging–guided EMB was performed, following a prespecified protocol. Sports eligibility status was redefined at 6-month follow-up. Results: From our sample, 188 athletes (82.8%) underwent EAM and EPS, and 42 (15.2%) underwent EMB. A diagnosis of heart disease could be formulated in 30% of the study population (67/227; 95% confidence interval [CI] 0.24–0.36) after noninvasive tests; in 37% (83/227; 95% CI 31%–43%) after EPS and EAM; and in 45% (102/227; 95% CI 39%–51%) after EMB. In the subset of athletes undergoing EMB, invasive diagnostic workup allowed diagnostic reclassification of half of the athletes (n = 21 [50%]). Reclassification was particularly common among subjects without definitive findings after noninvasive evaluation (n = 23; 87% reclassified). History of syncope, abnormal echocardiogram, presence of late gadolinium enhancement, and abnormal EAM were linked to sports ineligibility at 6-month follow-up. Conclusion: A comprehensive invasive workup provided additional diagnostic elements and could improve the sports eligibility assessment of athletes presenting with VAs. The extensive invasive evaluation presented could be especially helpful when noninvasive tests show unclear findings.
KW - Arrhythmogenic right ventricular cardiomyopathy
KW - Athletes
KW - Electroanatomic mapping
KW - Endomyocardial biopsy
KW - Myocarditis
KW - Ventricular arrhythmias
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U2 - 10.1016/j.hrthm.2021.09.013
DO - 10.1016/j.hrthm.2021.09.013
M3 - Article
C2 - 34536590
AN - SCOPUS:85116860588
SN - 1547-5271
VL - 19
SP - 90
EP - 99
JO - Heart Rhythm
JF - Heart Rhythm
IS - 1
ER -