6. Heidbuchel H, Panhuyzen-Goedkoop, Corrado D, Hoffmann E, Biffi A, Delise P, Blomstrom-Lundqvist C, Vanhees L, Hoffmann PI, Dorwarth U, Pelliccia A. Recommendations for participation in leisure-time physical activity and competitive sports for patients with arrhythmias and potentially arrhythmogenic conditions. Part I: supraventricular arrhythmias and pacemakers. Eur J Cardiovasc Prev Rehab 2006;13:485-94 7. Heidbuchel H, Corrado D, Biffi A, Hofmann E, Panhuyzen-Goedkoop N, Hoogsteen J, Delise P, Hoff PI, Pelliccia A. Recommendations for participation in leisure-time physical activity and competitive sports for patients with arrhythmias and potentially arrhythmogenic conditions. Part II: ventricular arrhythmias, channelopathies and implantable defibrillators. Eur J Cardiovasc Prev Rehab 2006;13:676-86 This document was developed in collaboration between the American Medical Society for Sports Medicine (AMSSM), the Section on Sports Cardiology of the European Association for Cardiovascular Prevention and Rehabilitation (EACPR), a registered branch of the European Society of Cardiology (ESC), the FIFA Medical Assessment and Research Center (F-MARC), and the Pediatric & Congenital Electrophysiology Society (PACES). 2013;47:153–167 Abstract Cardiac channelopathies are potentially lethal inherited arrhythmia syndromes and an important cause of sudden cardiac death (SCD) in young athletes. Other cardiac rhythm and conduction disturbances also may indicate the presence of an underlying cardiac disorder. The 12-lead ECG is utilised as both a screening and a diagnostic tool for detecting conditions associated with SCD. Fundamental to the appropriate evaluation of athletes undergoing ECG is an understanding of the ECG findings that may indicate the presence of a pathological cardiac disease. This article describes ECG findings present in primary electrical diseases afflicting young athletes and outlines appropriate steps for further evaluation of these ECG abnormalities. The ECG findings defined as abnormal in athletes were established by an international consensus panel of experts in sports cardiology and sports medicine. Introduction Inherited primary arrhythmia syndromes are known causes of sudden cardiac death (SCD) in young athletes. Channelopathies represent a heterogeneous group of genetically distinct cardiovascular disorders associated with sudden death and ventricular arrhythmias from disturbed function of the cardiac ion channel.1–3 Ventricular pre-excitation and other disturbances of cardiac conduction also are associated with diseases predisposing to SCD in young athletes.4 Primary electrical disorders may present with disease-related symptoms or be asymptomatic and thus only identified by abnormal testing during preparticipation screening. The 12-lead ECG is commonly abnormal among athletes with pathological cardiac disease, and clinicians responsible for ECG interpretation in athletes must be familiar with key findings associated with conditions at risk for SCD. This paper will review ECG findings associated with young athlete. Initial testing for further evaluation of abnormal ECG findings is also presented. Distinguishing normal from abnormal A challenge in the use of ECG for screening or diagnostic evaluations in athletes is the ability to accurately differentiate findings suggestive of a potentially lethal cardiovascular disorder from benign physiological adaptations occurring as the result of regular, intense training (ie, athlete’s heart). Several reports have outlined ECG criteria intended to distinguish normal ECG findings in athletes from ECG abnormalities requiring additional evaluation.5–10 On 13–14 February 2012, an international group of experts in sports cardiology and sports medicine convened in Seattle, Washington, to define contemporary standards for ECG interpretation in athletes. The objective of the meeting was to assist physicians distinguish normal ECG alterations in athletes from abnormal ECG findings that require additional evaluation for conditions that predispose to SCD.11 A review of normal ECG findings in athletes is presented separately.12 In this paper, abnormal ECG findings suggestive of an ion channel or conduction disorder associated with SCD in nummer 5 | november 2013 | Sport & Geneeskunde 21 Pagina 20
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