Maria Lucia Narducci1, Gemma Pelargonio2, Giulio La Rosa3, Frediano Inzani4, Giulia d'Amati5, Valeria Novelli6, Riccardo Marano7, Francesco Perna3, Gianluigi Bencardino3, Gaetano Pinnacchio3, Maurizio Genuardi8, Michela Cammarano9, Vincenzo Palmieri10, Paolo Zeppilli10, Filippo Crea2. 1. Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. Electronic address: marialucia.narducci@policlinicogemelli.it. 2. Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Istituto di Cardiologia, Università Cattolica del Sacro Cuore Rome, Rome, Italy. 3. Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. 4. Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. 5. Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy. 6. Dipartimento di Genetica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. 7. Istituto di Cardiologia, Università Cattolica del Sacro Cuore Rome, Rome, Italy; Dipartimento di Scienze Radiologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. 8. Istituto di Cardiologia, Università Cattolica del Sacro Cuore Rome, Rome, Italy; Dipartimento di Genetica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. 9. Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. 10. Istituto di Cardiologia, Università Cattolica del Sacro Cuore Rome, Rome, Italy; Istituto di Medicina Dello Sport, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
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.
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.
Authors: Paolo Compagnucci; Giovanni Volpato; Umberto Falanga; Laura Cipolletta; Manuel Antonio Conti; Gino Grifoni; Giuseppe Ciliberti; Giulia Stronati; Marco Fogante; Marco Bergonti; Elena Sommariva; Federico Guerra; Andrea Giovagnoni; Antonio Dello Russo; Michela Casella Journal: Medicina (Kaunas) Date: 2021-03-17 Impact factor: 2.430