ELECTROCARDIOGRAPHIC ANOMALIES - 3RD PART -

Ventricular Ectopic Beats (BEVs)

The BEV documentation on the basic ECG and / or in the stress test course (step test), requires further investigations: in the first instance the ECHO which must be mainly aimed at the search for arrhythmogenic pathologies, even silent ones (arrhythmogenic cardiomyopathy of the ventricle right, dilated, hypertrophic, ischemic, valve prolapses, myocarditis, congenital and valve heart disease, including operated, etc.), and secondly, maximal TE, MH and other 2nd level investigations.
Suitability may be considered in the presence of: asymptomatic, monomorphic, sporadic, non-repetitive, non-early, non-exercise-triggered BEVs; absence of heart disease or identifiable arrhythmogenic situations or intake of arrhythmogenic substances or drugs.
On the other hand, subjects with:

underlying heart disease;

electrophysiological aspects considered at risk: R / T phenomenon, tight pairs and triplets (R-R <400 msec) and frequent, ventricular tachycardia

4 or more consecutive beats) with HR> 120 bpm;

clear relationship of the arrhythmia with the physical effort of sporting activity.

In cases without evident heart disease but with electrophysiological aspects at risk, a useful measure for the purposes of a definitive judgment is to re-evaluate these subjects after 4 months of "detraining". In all other cases 3rd level exams are required for the granting of fitness for sport.

Slow ventricular tachycardia (TVL)

Idioventricular rhythms with a frequency <120 bpm mainly attributable to depression of the sinus function, generally do not represent a contraindication to sporting activity in the absence of heart disease. , both to evaluate the ability to increase the sinus frequency and the total cancellation of the TVL with the effort.
In addition, 2nd level six-monthly cardio-arrhythmological checks are mandatory.

Major ventricular hyperkinetic arrhythmias

The current and anamnestic finding of sustained ventricular tachycardia (TVS), torsade de pointes (TdP), and / or hyperkinetic arrest of circulation due to ventricular fibrillation (VF), absolutely contraindicates fitness to sport, unless a cardioarrhythmological study level 3 safely excludes the possibility of relapse.
Congenital long QT syndromes absolutely contraindicate any type of sports activity even in the absence of documented major ventricular hyperkinetic arrhythmias.
In doubtful cases (QT at the limits of the norm, familiarity), a 3rd level cardioarhythmological study is necessary.

Ventricular pre-excitation syndromes

These are pictures with ECG only diagnosis, in which the A-V conduction is accelerated, and the ventricular myocardium is activated through short circuits that bypass the normal A-V conduction pathways. If arrhythmic crises are associated (mostly paroxysmal supraventricular tachycardia or atrial fibrillation) we speak of Wolff-Parkinson-White syndrome.

The graphic ECG features consist of a shortening of the PR segment (less than 0.12 sets), a widening of the QRS complex, anomalies of the ventricular repolarization phase, and the presence of a ventricular pre-excitation wave, the delta wave.
The anomalous bundle responsible for the AV short circuit can directly connect the atrium to the ventricle (Kent bundle), or the atrium to the AV node (James fibers), or the bundle of His to the upper part of the interventricular septum (Mahaim fibers) ).
In most cases, W-P-W syndrome is found in healthy (80%) and mostly asymptomatic subjects; in the remaining cases, congenital heart disease (eg hypertrophic cardiomyopathy), hypertensive or ischemic heart disease can be associated. Excluding a basic heart disease, the clinical evaluation depends on the presence of symptoms, related to the frequency and severity of any tachyarrhythmic attacks; mostly these are paroxysmal supraventricular tachycardias, atrial flutter or fibrillation.
Remember that people with W-P-W syndrome can experience more severe arrhythmias, such as tachycardia and ventricular fibrillation, with the risk of sudden death.
Sports fitness, for asymptomatic subjects and without clinical and instrumental signs of heart disease, is subject to the execution of an electrophysiological study, which defines the type of cardiac pre-excitation and allows the detection of the most prognostically significant data.

Curated by: Lorenzo Boscariol

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