Assessment of premature ventricular beats in athletes

##plugins.themes.academic_pro.article.sidebar##

Published Sep 3, 2018
Download
pdf
Vol. 96 No. 4 (2018): Issue Apr 2018

##plugins.themes.academic_pro.article.main##

Afef Ben Halima
Manel Ben Halima
Zied BelHadj
Marouene Boukhris
Saida Ayachi
Hayet Ben Salah
Héla Addala
Anis Chaouachi
Donia Kobaa

Abstract

Introduction Premature ventricular complexes (PVC) are generally considered as a benign electrocardiographic abnormality in the athleticpopulation. However it may be indicative of underlying heart disease which may increase the risk of sudden death. This implies the need forcardiological evaluation before indicating the ability to practice competitive sports.
Aim: The aim of this study was to evaluate an athlete population with PVC and establish underlying etiologies in order to take a decisionregarding practicing sports.
Methods: This is a prospective study which included athletes examined in the Tunisian National Centre of Sports Medicine and Sports Science
(TNCSM) from January 2013 to June 2015 who presented PVC on an electrocardiogram
Results:5798 athletes were referred to the TNCSM . We identified 42 athletes having PVC with a prevalence of 1.8%. The average age of thestudy population was 21.6 ± 5.99 years. 83% were men. 88% were asymptomatic the electrocardiogram was considered normal in 62% ofthe athletes according to the Seattle criteria, At the Holter monitoring, the average number of PVC was 920 PVC / 24 hours. Thirteen athleteshad doublets and 11 had triplets. One patient had polymorphic PVC and an R/T phenomenon. The transthoracic echocardiography (TTE) wasnormal in 71 % of cases. Three athletes had hypertrophic cardiomyopathy (HCM). All patients underwent a stress test. The PVC disappearedin 12% of athletes. MRI was performed in 10 athletes confirming the three cases of HCM and revealing a case of arrhythmogenic rightventricular dysplasia and a case of compression of the right ventricle by pectusexacavatum
Conclusion: After this assessment, five athletes were not allowed to practice sport. This study shows the necessity of a thorough cardiological
assessment of athletes with ventricular arrhythmia in order to detect underlying heart disease and prevent sudden death in this young apparentlyhealthy population

Keywords:

Athletes; Premature ventricular contraction; echocardiography; stress test; Holter monitoring; Magnetic resonance imaging; Sudden death.

##plugins.themes.academic_pro.article.details##

References

  1. Hiss RG, Lamb LE. Electrocardiographic findings in 122,043 individuals.Circulation 1962;25:947-61.
  2. Raftery EB, CashmanPM .Long-term recording of the electrocardiogramin a normal population. Postgrad Med J 1976;52Suppl7:32-7.
  3. Bjerregaard P. Premature beats in healthy subjects 40-79 years of age.Eur Heart J 1982;3:493-503.
  4. Fleg JL, Kennedy HL. Cardiac arrhythmias in a healthy elderlypopulation: detection by 24-hour ambulatory electrocardiography.Chest 1982;81:302-7.
  5. Kostis JB, McCrone K, Moreyra AE et al. Premature ventricularcomplexes in the absence of identifiable heart disease. Circulation1981;63:1351-6
  6. Maron BJ, Shirani J, Poliac LC et al. Sudden death in young competitive athletes: clinical, demographicand pathological profiles. JAMA 1996;276:199-204.
  7. Corrado D, Basso C, Schiavon M et al. .Screening for hypertrophiccardiomyopathy in young athletes. N Engl J Med 1998;339:364-9.
  8. Maron BJ, Gohman TE, Aeppli D. Prevalence of sudden death duringcompetitive sports activities in Minnesota high school athletes. J AmCollCardiol 1998;32:1881-4.
  9. Furlanello F, Bertoldi A, Dallago M et al. Cardiac arrest and suddendeath in competitive athletes with arrhythmogenic right ventriculardysplasia. PacingClinElectrophysiol1998;21:331-5.
  10. Maron BJ. Sudden death in young athletes: lesson from the HankGathers affair. N Engl J Med 1993;329:55-7.
  11. Corrado D, Pelliccia A, Heidbuchel et al. Recommendations forinterpretation of 12-lead electrocardiogram in the athlete. EurHeart J2010;31:243e259.
  12. Uberoi A, Stein R, Perez MV et al. Interpretation of the electrocardiogramof young athletes. Circulation 2011;124:746e- 757
  13. Kosowsky BD, Lown B, Whiting R et al. .Occurrence of ventricular arrhythmias with exercise as compared to monitoring circulation 1971Nov;44(5):826-32
  14. A. Biffi, A Pelliccia, L Verdile et al. Long-Term Clinical Significanceof Frequent and Complex VentricularTachyarrhythmias in Trained Athletes.J Am CollCardiol 2002;40:446 -52
  15. Steriotis AK1, Nava A, Rigato I et al. Noninvasive cardiac screening in young athletes with ventricular arrhythmias.Am J Cardio 2013;111:557-562
  16. T Fuchs, A Torjman,L Galitzkaya et al. The Clinical Significance of Ventricular Arrhythmiasduring an Exercise Test in Non-Competitiveand Competitive Athletes IMAJ 2011; 13: 735-739
  17. P Delise, N Sitta, E Lanari et al. Long-Term Effect of Continuing Sports Activity in CompetitiveAthletes With Frequent Ventricular Premature Complexesand Apparently Normal Heart. Am J Cardio l 2013;112:1396 -1402
  18. Biffi A, Maron BJ, Di Giacinto B et al. Relation between training-induced left ventricular hypertrophy and risk for ventricular tachyarrhythmias in elite athletes. Am J Cardiol.2008 Jun 15;101(12):1792-5
  19. Huston P, Puffer JC, MacMillan RW. The athletic heart syndrome.N Engl J Med 1985;315:24-32.
  20. A Biffi, BJMaron, L Verdile et al. Impact of Physical Deconditioning on Ventricular Tachyarrhythmias in Trained Athletes.J Am CollCardiol 2004;44:1053- 8
  21. Fazio G, Novo G, Sutera L et al. Sympathetic tone and ventricular tachycardia.J CardiovascMed 2008;9:963-966.
  22. Ueno LM, Moritani T. Effects of long-term exercise training on cardiacautonomic nervous activities and baroreflex sensitivity. EurJ ApplPhysiol2003;89:109 -114.
  23. O'Sullivan SE, Bell C. The effects of exercise and training on humancardiovascular reflex control. J AutonNervSyst2000;81:16 -24.
  24. Chen LS, Zhou S, Fishbein MC et al. New perspectives on therole of autonomic nervous system in the genesis of arrhythmias.J CardiovascElectrophysiol2007;18:123-127.
  25. Iellamo F, Legramante JM, Pigozzi F et al. Conversion from vagal to sympathetic predominancewith strenuous training in high-performance world class athletes. Circulation2002;105:2719 -2724.
  26. Freek R. van de Schoor. Mayo Clin Proc. 2016;91(11):1617-1631.
  27. Dello Russo A, Pieroni M, Santangeli P et al. Concealed cardiomyopathies in competitive athletes with ventricular arrhythmias and an apparently normal heart: role of cardiac electroanatomical mapping and biopsy. Heart Rhythm. 2011 Dec;8(12):1915-22
  28. Mousavi N, Czarnecki A, Kumar K, et al. Relation of biomarkersand cardiac magnetic resonance imaging after marathonrunning. Am J Cardiol. 2009;103(10):1467-1472.
  29. Hanssen H, Keithahn A, Hertel G, et al. Magnetic resonance imagingof myocardial injury and ventricular torsion after marathonrunning. Clin Sci (Lond). 2011;120(4):143-152.
  30. Trivax JE, Franklin BA, Goldstein JA, et al. Acute cardiac effectsof marathon running. J ApplPhysiol (1985). 2010;108(5):1148-1153.
  31. Gaudreault V, Tizon-Marcos H, Poirier P, et al. Transientmyocardial tissue and function changes during a marathon inless fit marathon runners. Can J Cardiol. 2013;29(10):1269-1276.
  32. O'Hanlon R, Wilson M, Wage R, et al. Troponin releasefollowing endurance exercise: is inflammation the cause? a cardiovascularmagnetic resonance study. J CardiovascMagn Reson.2010;12:38
  33. Rimensberger C, Carlen F, Brugger Net al. Right ventricular adaptations and arrhythmias in amateur ultra-endurance athletes.Br J Sports Med.2014;48(15):1179-84.
  34. Bohm P, Schneider G, Linneweber Let al. Right and Left Ventricular Function and Mass in Male Elite Master Athletes: A Controlled Contrast-Enhanced Cardiovascular Magnetic Resonance Study.Circulation2016;133(20):1927-35
  35. Strain JE, Grose RM, Factor SM et al. Results of endomyocardialbiopsy in patients with spontaneous ventricular tachycardia butwithout apparent structural heart disease. Circulation 1983;68:1171-81.
  36. Vignola PA, Aonuma K, Swaye PS, et al. Lymphocytic myocarditispresenting as unexplained ventricular arrhythmias: diagnosis withendomyocardial biopsy and response to immunosuppression. J AmCollCardiol 1984;4:812-9.
  37. Suwa M, Hirota Y, Nagao H et al. Incidence of thecoexistence of left ventricular false tendons and premature contractionsin apparently healthy subjects. Circulation 1984;70:793-8.
  38. Kekakis J, Antonious A, Prassopoulas V et al. Regional adrenergic denervation in ventricular fibrillation withoutapparent heart disease. Am Heart J 1994;127:952-3.
  39. CT Pedersen, GN Kay, J Kalman et al. EHRA/HRS/APHRS Expert Consensus on VentricularArrhythmias.Heart Rhythm, Vol 11, No 10, October 2014 e170
  40. DP Zipes.Eligibility and DisqualificationRecommendations for Competitive AthletesWith Cardiovascular Abnormalities:Task Force 9: Arrhythmias andConduction Defects. J Am CollCardiol 2015; 66 , NO . 2 1 , 2 0 1 5