Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes.

Nicola Tarantino,Domenico Della Rocca,Giovanni Forleo,Carola Gianni,Michele Magnocavallo,Chintan Trivedi,Nicole De Leon De La Cruz,Luigi Di Biase,Amin Al-Ahmad,Eric Manheimer,G Gallinghouse,Rodney Horton,J Burkhardt,Mohamed Bassiouny,Carlo Lavalle,Sanghamitra Mohanty,Andrea Natale

doi:10.3390/medicina57030205

Abstract

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.

Highlights

IntroductionConsidering that valvular and congenital cardiac defects, aortic dissection, myocarditis, and negative autopsy represent 40% of the findings, the net majority of life-threatening events in athletes is ascribable to primarily arrhythmogenic ventricular cardiac conditions, such as inherited/acquired cardiomyopathies (i.e., arrhythmogenic dysplasia (ARVD), idiopathic hypertrophy), coronary artery disease (CAD), and channelopathies [2]
A statistically non-significant trend of arrhythmia-free survival was noted after multiple procedures in the combined endo-epicardial approach group after just one year compared to endocardial ablation only (75% vs. 53%, p = 0.058)
Full non-invasive diagnosis is mandatory during the screening for eligibility, and both a 12-lead extended telemetry or exercise stress test with detailed imaging are critical to delineate the origin of the ventricular arrhythmias (VAs), often featuring a non-ischemic source and arising from the right ventricle (RV) rather than the left ventricle (LV)

Summary

Introduction

Considering that valvular and congenital cardiac defects, aortic dissection, myocarditis, and negative autopsy represent 40% of the findings, the net majority of life-threatening events in athletes is ascribable to primarily arrhythmogenic ventricular cardiac conditions, such as inherited/acquired cardiomyopathies (i.e., arrhythmogenic dysplasia (ARVD), idiopathic hypertrophy), coronary artery disease (CAD), and channelopathies [2]. The cardiac remodeling triggered by intense regular physical activity is responsible for the impairment of the electrical milieu [3,4]. Such remodeling sometimes configures peculiar electro-anatomical pictures for both the atrium and the ventricle [4,5,6,7,8]. Ventricular manifestations of rhythm disorders are common in professional and semi-professional athletes [9], some of which are either genuinely symptomatic or concerned for a possible non-eligibility to official competitions

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