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.

Narducci, M. L., 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., Role of extensive diagnostic workup in young athletes and nonathletes with complex ventricular arrhythmias, <<HEART RHYTHM>>, 2020; 17 (2): 230-237. [doi:10.1016/j.hrthm.2019.08.022] [http://hdl.handle.net/10807/151436]

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

Narducci M. L.;Pelargonio G.;Inzani F.;Novelli V.;Marano R.;Perna F.;Bencardino G.;Pinnacchio G.;Genuardi M.;Cammarano M.;Zeppilli P.;Crea F.
Ultimo
2020

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.
Inglese
Narducci, M. L., 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., Role of extensive diagnostic workup in young athletes and nonathletes with complex ventricular arrhythmias, <>, 2020; 17 (2): 230-237. [doi:10.1016/j.hrthm.2019.08.022] [http://hdl.handle.net/10807/151436]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/151436
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