Ventricular arrhythmias and athlete's heart. Role of signal-averaged electrocardiography.

The aim of this study was to assess the prevalence and the prognostic value of ventricular late potentials in apparently healthy top-level athletes with ventricular arrhythmias, and the effect of physiological myocardial hypertrophy (athlete's heart) on the electrogenesis of the signal-averaged electrocardiogram (ECG). Two groups of asymptomatic athletes without underlying heart disease were studied: group A consisted of 35 athletes without arrhythmias and group B of 25 athletes with frequent and complex ventricular arrhythmias (ventricular ectopic beats > 5000.24 h-1 and ventricular couplets > 15.24 h-1). Late potentials were present if athletes had significantly prolonged filtered QRS and low amplitude signal duration and low root mean square voltages at both 25-250 Hz and 40-250 Hz filters. While late potentials were absent in all normal athletes of group A, they were present in seven of 25 (28%) athletes with arrhythmias of group B (P < 0.003). Ten of 25 athletes (five with and five without late potentials) of group B underwent programmed ventricular stimulation using a protocol comprising up to three extrastimuli. No episode of sustained ventricular tachycardia was induced. In four of five athletes with late potentials and in one of five without them, unsustained ventricular responses were induced. Echocardiographically determined left ventricular mass found in both groups of athletes did not influence the pathological result of the signal-averaged ECG parameters. This study shows the applicability of the signal-averaged ECG in identifying ventricular late potentials in a selected population of top-level athletes with frequent and complex ventricular arrhythmias and without overt heart disease; it also shows that the presence of late potentials is not influenced by left ventricular mass, even if extreme ( > 350 g), and it is correlated to a non-sustained ventricular response during an electrophysiological study.

[1]  A. Pelliccia,et al.  Arrhythmias in athletes. , 1986, American heart journal.

[2]  R J Prineas,et al.  Relation between ventricular premature complexes and sudden cardiac death in apparently healthy men. , 1987, The American journal of cardiology.

[3]  A. Camm,et al.  Risk stratification for arrhythmic events in postinfarction patients based on heart rate variability, ambulatory electrocardiographic variables and the signal-averaged electrocardiogram. , 1991, Journal of the American College of Cardiology.

[4]  M. Simson Use of Signals in the Terminal QRS Complex to Identify Patients with Ventricular Tachycardia After Myocardial Infarction , 1981, Circulation.

[5]  P. Palatini,et al.  Prevalence and possible mechanisms of ventricular arrhythmias in athletes. , 1985, American heart journal.

[6]  W. Mckenna,et al.  Significance of signal-averaged electrocardiography in relation to endomyocardial biopsy and ventricular stimulation studies in patients with ventricular tachycardia without clinically apparent heart disease. , 1989, Journal of the American College of Cardiology.

[7]  E. Olsen Pathology of primary cardiomyopathies. , 1972, Postgraduate medical journal.

[8]  J. Vacek,et al.  The effects of exercise during viremia on the signal-averaged electrocardiogram. , 1990, American heart journal.

[9]  M. Dallago,et al.  Life-threatening tachyarrhythmias in athletes. , 1992, Pacing and clinical electrophysiology : PACE.

[10]  V Hombach,et al.  Standards for analysis of ventricular late potentials using high-resolution or signal-averaged electrocardiography: a statement by a task force committee of the European Society of Cardiology, the American Heart Association, and the American College of Cardiology. , 1991, Journal of the American College of Cardiology.

[11]  A. Raineri,et al.  Quantitative analysis of ventricular late potentials in healthy subjects. , 1990, The American journal of cardiology.

[12]  M. Proschan,et al.  The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. , 1991, The New England journal of medicine.

[13]  A. DeMaria,et al.  Recommendations Regarding Quantitation in M-Mode Echocardiography: Results of a Survey of Echocardiographic Measurements , 1978, Circulation.

[14]  P. Denes,et al.  Quantitative Analsis of the High‐frequency Components of the Terminal Portion of the Body Surface QRS in Normal Subjects and in Patients with Ventricular Tachycardia , 1983, Circulation.

[15]  J. Mcanulty,et al.  Analysis of programmed stimulation methods in the evaluation of ventricular arrhythmias in patients 20 years old and younger. , 1990, The American journal of cardiology.

[16]  A. Raineri,et al.  Relation between late potentials and echocardiographically determined left ventricular mass in healthy subjects. , 1991, The American journal of cardiology.

[17]  W. Mckenna,et al.  Signal-averaged electrocardiography in hypertrophic cardiomyopathy. , 1990, Journal of the American College of Cardiology.

[18]  Harold L. Kennedy,et al.  Long-term follow-up of asymptomatic healthy subjects with frequent and complex ventricular ectopy. , 1985, The New England journal of medicine.

[19]  J M Fontaine,et al.  Value of the signal-averaged electrocardiogram as a predictor of the results of programmed stimulation in nonsustained ventricular tachycardia. , 1988, The American journal of cardiology.

[20]  N Reichek,et al.  Echocardiographic Determination of Left Ventricular Mass in Man: Anatomic Validation of the Method , 1977, Circulation.

[21]  R. Pedretti,et al.  Prediction of late arrhythmic events after acute myocardial infarction from combined use of noninvasive prognostic variables and inducibility of sustained monomorphic ventricular tachycardia. , 1993, The American journal of cardiology.