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

Heart Rhythm. 2020 Feb;17(2):230-237. doi: 10.1016/j.hrthm.2019.08.022. Epub 2019 Aug 28.

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.

Keywords: 3D-EAM guided endomyocardial biopsy; Athletes; Innovative biotechnology; Personalized medicine; Ventricular arrhythmia.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Athletes*
  • Biopsy / methods*
  • Echocardiography / methods*
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Genetic Testing / methods*
  • Humans
  • Imaging, Three-Dimensional / methods*
  • Magnetic Resonance Imaging, Cine / methods*
  • Male
  • Prospective Studies
  • Reproducibility of Results
  • Tachycardia, Ventricular / diagnosis*
  • Tachycardia, Ventricular / physiopathology