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

  • Maria Lucia Narducci
    Correspondence
    Address reprint requests and correspondence: Dr Maria Lucia Narducci, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli, 8, Rome 00168, Italy.
    Affiliations
    Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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  • Gemma Pelargonio
    Affiliations
    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
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  • Giulio La Rosa
    Affiliations
    Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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  • Frediano Inzani
    Affiliations
    Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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  • Giulia d’Amati
    Affiliations
    Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
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  • Valeria Novelli
    Affiliations
    Dipartimento di Genetica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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  • Riccardo Marano
    Affiliations
    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
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  • Francesco Perna
    Affiliations
    Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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  • Gianluigi Bencardino
    Affiliations
    Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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  • Gaetano Pinnacchio
    Affiliations
    Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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  • Maurizio Genuardi
    Affiliations
    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
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  • Michela Cammarano
    Affiliations
    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
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  • Vincenzo Palmieri
    Affiliations
    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
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  • Author Footnotes
    1 Drs Zeppilli and Crea contributed equally to this manuscript
    Paolo Zeppilli
    Footnotes
    1 Drs Zeppilli and Crea contributed equally to this manuscript
    Affiliations
    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
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  • Author Footnotes
    1 Drs Zeppilli and Crea contributed equally to this manuscript
    Filippo Crea
    Footnotes
    1 Drs Zeppilli and Crea contributed equally to this manuscript
    Affiliations
    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
    Search for articles by this author
  • Author Footnotes
    1 Drs Zeppilli and Crea contributed equally to this manuscript
Published:August 27, 2019DOI:https://doi.org/10.1016/j.hrthm.2019.08.022

      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

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