Ventricular arrhythmias in competitive athletes: risk stratification with T-wave alternans
Abstract
Overview
Introduction. Aim of our study is to evaluate the role of TWA to stratify the risk of
sudden cardiac death in athletes (Ath) with complex ventricular arrhythmias (VA), and to document
a possible correlation between TWA and electrophysiological testing (EES) results.
Methods. We studied 43 Ath with VA (31 M, mean age 34 ± 12 years). In all cases a cardiological
evaluation was performed, including TWA and EES. The patients were evaluated during a followup
of 25 ± 22 months. The end-point was the occurrence of sudden death or malignant ventricular
tachyarrhythmias (VT).
Results. TWA was negative in 28 Ath (65%), positive in 8 (19%) and indeterminate in 7 (16%). All
subjects with negative TWA did not show induction of VT at EES, with significant correlation between
negative TWA and negative EES (p<0.001). All Ath with positive TWA also had VT induced
by a EES, but without significant correlation between positive TWA and positive EES. In 2 Ath
with undetermined TWA (29%) VT were induced at EES. Our data did not show significant correlation
between indeterminate TWA and positive or negative EES. However, logistic regression
analysis showed significant correlation between abnormal TWA test (positive or indeterminate)
and inducibility of VT at EES (p<0.001). During follow-up we observed a significant difference in
end-point occurrence between Ath with negative or positive TWA and between Ath with negative
or positive EES.
Conclusion. TWA confirm its role as a simple and non-invasive test, and it seems useful for prognostic
stratification of Ath with VA. (Heart International 2007; 3: 58-67)
Keywords
T-wave alternans, Sudden death, Ventricular arrhythmias, Sport activity
Article Information
Correspondence
Giuseppe Inama, MD, Department of Cardiology, Ospedale Maggiore, L.go U. Dossena, 2, 26013 Crema – Italy, g.inama@hcrema.it
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