Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes

A recent surveillance analysis indicates that cardiac arrest/death occurs in ≈1:50,000 professional or semi-professional athletes, and the most common cause is attributable to life-threatening ventricular arrhythmias (VAs). It is critically important to diagnose any inherited/acquired cardiac disease, including coronary artery disease, since it frequently represents the arrhythmogenic substrate in a substantial part of the athletes presenting with major VAs. New insights indicate that athletes develop a specific electro-anatomical remodeling, with peculiar anatomic distribution and VAs patterns. However, because of the scarcity of clinical data concerning the natural history of VAs in sports performers, there are no dedicated recommendations for VA ablation. The treatment remains at the mercy of several individual factors, including the type of VA, the athlete’s age, and the operator’s expertise. With the present review, we aimed to illustrate the prevalence, electrocardiographic (ECG) features, and imaging correlations of the most common VAs in athletes, focusing on etiology, outcomes, and sports eligibility after catheter ablation.

[1]  Tanaka,et al.  The role of , 2021, Journal of insect physiology.

[2]  Kristen L. Kucera,et al.  Aetiology and incidence of sudden cardiac arrest and death in young competitive athletes in the USA: a 4-year prospective study , 2020, British Journal of Sports Medicine.

[3]  A. Natale,et al.  Epicardial Ablation Complications. , 2020, Cardiac electrophysiology clinics.

[4]  D. Andreini,et al.  Diagnostic Yield of Electroanatomic Voltage Mapping in Guiding Endomyocardial Biopsies , 2020, Circulation.

[5]  Dhanunjaya R. Lakkireddy,et al.  First-line ablation of ventricular tachycardia in ischemic cardiomyopathy: stratification of outcomes by left ventricular function , 2020, Journal of Interventional Cardiac Electrophysiology.

[6]  H. Heidbuchel,et al.  Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part 2: ventricular arrhythmias, channelopathies, and implantable defibrillators. , 2020, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[7]  Dhanunjaya R. Lakkireddy,et al.  Implantable loop recorders for cardiac dysrhythmia monitoring. , 2020, Future cardiology.

[8]  N. Brunetti,et al.  On the role of echocardiography and beta‐receptors downregulation in multipattern Takotsubo , 2020, Echocardiography.

[9]  J. McKinney,et al.  Do athletes play by different rules? Obstructive coronary artery disease in asymptomatic competitive Masters athletes: a case series , 2020, European heart journal. Case reports.

[10]  Dhanunjaya R. Lakkireddy,et al.  Role of the Left Atrial Appendage in Systemic Homeostasis, Arrhythmogenesis, and Beyond. , 2020, Cardiac electrophysiology clinics.

[11]  J. Burkhardt,et al.  Association of fragmented QRS with left atrial scarring in patients with persistent atrial fibrillation undergoing radiofrequency catheter ablation. , 2020, Heart rhythm.

[12]  F. Fedele,et al.  Electrocardiographic features, mapping and ablation of idiopathic outflow tract ventricular arrhythmias , 2019, Journal of Interventional Cardiac Electrophysiology.

[13]  N. Mercuri,et al.  Feasibility of automated detection of sleep apnea using implantable pacemakers and defibrillators: a comparison with simultaneous polysomnography recording , 2019, Journal of Interventional Cardiac Electrophysiology.

[14]  J. Burkhardt,et al.  Ablation Index as a predictor of long-term efficacy in premature ventricular complex ablation: A regional target value analysis. , 2019, Heart rhythm.

[15]  A. Natale,et al.  The Value of Baseline and Arrhythmic ECG in the Interpretation of Arrhythmic Mechanisms. , 2019, Cardiac electrophysiology clinics.

[16]  F. Marchlinski,et al.  Variant of ventricular outflow tract ventricular arrhythmias requiring ablation from multiple sites: Intramural origin. , 2019, Heart rhythm.

[17]  K. Kuck,et al.  Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Sequential Approach , 2019, Journal of the American Heart Association.

[18]  A. Natale,et al.  Role of surface electrocardiogram in the era of high-resolution mapping and imaging systems-back to the future. , 2019, Journal of thoracic disease.

[19]  A. Natale,et al.  Percutaneous Treatment of Non-paroxysmal Atrial Fibrillation: A Paradigm Shift from Pulmonary Vein to Non-pulmonary Vein Trigger Ablation? , 2018, Arrhythmia & electrophysiology review.

[20]  William J. Bryant,et al.  2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. , 2018, Circulation.

[21]  H. Heidbuchel.  The athlete’s heart is a proarrhythmic heart, and what that means for clinical decision making , 2018, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[22]  D. Corrado,et al.  Ventricular Arrhythmias in Young Competitive Athletes: Prevalence, Determinants, and Underlying Substrate , 2018, Journal of the American Heart Association.

[23]  A. Natale,et al.  Localization of Ventricular Arrhythmias for Catheter Ablation: The Role of Surface Electrocardiogram. , 2018, Cardiac electrophysiology clinics.

[24]  N. Brunetti,et al.  "PAFIYAMA" syndrome; further evidence on a novel clinical entity. , 2018, International journal of cardiology.

[25]  G. Lippi,et al.  PAFIYAMA syndrome evidence in highly trained population. , 2018, International journal of cardiology.

[26]  D. Jacoby,et al.  Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) in a young female athlete at 36 weeks gestation: a case report. , 2017, Pathology, research and practice.

[27]  F. Romeo,et al.  Arrhythmogenic right-ventricular cardiomyopathy and cardiac microvascular disease: a rare association or a possible link? , 2017, Journal of cardiovascular medicine.

[28]  Mathew G. Wilson,et al.  Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes With a Low Atherosclerotic Risk Profile , 2017, Circulation.

[29]  M. Schalij,et al.  Isolated Subepicardial Right Ventricular Outflow Tract Scar in Athletes With Ventricular Tachycardia. , 2017, Journal of the American College of Cardiology.

[30]  D. Andreini,et al.  Ventricular arrhythmias induced by long-term use of ephedrine in two competitive athletes , 2015, Heart and Vessels.

[31]  A. Natale,et al.  Novel Perspectives on Arrhythmia-Induced Cardiomyopathy: Pathophysiology, Clinical Manifestations and an Update on Invasive Management Strategies , 2014, Cardiology in review.

[32]  A. Natale,et al.  Concealed cardiomyopathies in competitive athletes with ventricular arrhythmias and an apparently normal heart: role of cardiac electroanatomical mapping and biopsy. , 2011, Heart rhythm.

[33]  F. Romeo,et al.  Predictive value of fragmented QRS in primary prevention implantable cardioverter defibrillator recipients with left ventricular dysfunction , 2011, Journal of cardiovascular medicine.

[34]  A. Verma,et al.  Ablation of Ventricular Arrhythmias in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy: Arrhythmia-Free Survival After Endo-Epicardial Substrate Based Mapping and Ablation , 2011, Circulation. Arrhythmia and electrophysiology.

[35]  W. Stevenson,et al.  Long-Term Outcomes of Combined Epicardial and Endocardial Ablation of Monomorphic Ventricular Tachycardia Related to Hypertrophic Cardiomyopathy , 2011, Circulation. Arrhythmia and electrophysiology.

[36]  Dhanunjaya R. Lakkireddy,et al.  Radiofrequency catheter ablation of ventricular arrhythmias in patients with hypertrophic cardiomyopathy: safety and feasibility. , 2010, Heart rhythm.

[37]  C. Schernthaner,et al.  T‐Wave Oversensing by an Implantable Cardioverter Defibrillator after Successful Ablation of Idiopathic Ventricular Fibrillation , 2006, Pacing and clinical electrophysiology : PACE.

[38]  H. Heidbuchel,et al.  High prevalence of right ventricular involvement in endurance athletes with ventricular arrhythmias. Role of an electrophysiologic study in risk stratification. , 2003, European heart journal.

[39]  B. Maron,et al.  Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes. , 2002, Journal of the American College of Cardiology.

[40]  F O Mueller,et al.  Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. , 1996, JAMA.

[41]  A. Natale,et al.  Long-term outcomes of different ablation strategies for ventricular tachycardia in patients with structural heart disease: systematic review and meta-analysis , 2018, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[42]  Andrea Mazzanti,et al.  [2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death]. , 2015, Kardiologia polska.

[43]  A. P. Riera,et al.  Idiopathic intrafascicular reentrant left ventricular tachycardia in an elite cyclist athlete. , 2009, Cardiology Journal.

[44]  S. Weidmann.  [Ectopic beats]. , 1973, Swiss medical weekly.