Arrhythmological sudden death in athletes - electrophysiological assessment and management

Abstract

Background. The assessment by electrophysiological study of sudden cardiac death risk of pure arrhythmological origin in the athletes with positive history of tachycardia was not previously described by the literature.
Method and results. A prospective study conducted between 2010 and 2014 which included 62 patients, all athletes, performing category IIA sports or higher according to Bethesda Classification of sports, with positive history of arrhythmia (ECG documentation; syncope or aborted cardiac arrest; suggestive symptoms). All patients were evaluated by non invasive (ECG, effort testing) and invasive testing (electrophysiological study). The radiofrequency ablation was done in selected patients. The mean age of all patients was 17.62±6 years. There were found 29 patients (46.77%) with sudden cardiac death risk, from which 15 patients (24.19%) had only symptoms, not previous ECG documentation of arrhythmia and were discovered with high sudden death risk at electrophysiological study. The most common types of arrhythmia associated with sudden death risk were found to be the Wolff-Parkinson-White syndrome, atrioventricular nodal reentrant tachycardia and atrioventricular reciprocating orthodromic tachycardia due to concealed accessory pathways, ventricular tachycardia and premature ventricular contractions with degeneration into ventricular tachycardia.
Conclusions. The sudden death risk is much more spread than thought among the athletes. This is due to cardiac remodeling at one hand and to associated discrete pathologic conditions on the other hand. Even if there is no documented tachycardia but the symptoms are suggestive for arrhythmic events, further investigation by effort testing and electrophysiological study in selected cases must be done. The two mechanisms of death that we assessed in association with the above described arrhythmias are degeneration into VF or hypo diastolic shock with hemodynamic collapse due to very fast tachycardia. In almost all cases, the radiofrequency ablation was the complete curative method, permitting the continuation of sports.

Key words:

athletes, sudden cardiac death, supraventricular tachycardia, ventricular tachycardia, electrophysiological study, screening