Arrhythmogenic right ventricular dysplasia (ARVD) is a predisposing factor for sport-related cardiac arrest (CA), sudden cardiac death (SD), and life-threatening ventricular tachyarrhythmias (VT). The aim of this study was the assessment of athletes with ARVD, particularly the CA survivors. From 1974 to January 1996, 1642 competitive athletes (aver. 25.5 yr.), 136 of whom were top level athletes (TLA), were studied for important arrhythmic manifestations. All athletes underwent an individualised study protocol including a series of non invasive and invasive diagnostic techniques. One hundred and one athletes (90 males, 11 females, aver. 25.9 yr.) were diagnosed as being affected by ARVD on the basis of the WHO/ISFC criteria. The same percentage (about 6%) of ARVD is present in both the general arrhythmic athletes population and in the subgroup of TLA. Prevalence of ARVD among athletes with CA or SD is high (respectively 23% and 25%), confirming the observation that ARVD is one of the major causes of SD in Italian athletes. All CA were athletic activity related, indicating the potentiality of exercise as a cause of electrical destabilisation in subjects with ARVD. In athletes with documented ARVD intense sport activity has to be proscribed. In athletes at risk of CA or SD an aggressive treatment, ICD implantation and RF catheter ablation must be taken into consideration.

Arrhythmogenic right ventricular dysplasia (ARVD) is a typical 'silent' arrhythmogenic cardiomyopathy in athletes, with the possibility of normal ventricular performance and life-threatening arrhythmias. We studied 32 athletes (28 M, 4 F), mean age 23 years, follow-up 6.7 years, all previously declared fit for sports activity. They were studied for significant ventricular arrhythmias with LBBB with a final diagnosis of ARVD based on accepted clinical, echocardiographic and angiographic criteria. The study protocol included Holter monitoring (HM), stress test (ST), electrophysiological endocavitary study (EES), 2D echocardiography, RV and LV cardioangiography and coronarography. The most serious arrhythmia appeared at a mean age of 23.4 years, 20 had clinical sustained ventricular tachycardia (VT) (19/20, 95% during sports activity), six non-sustained VT and one ventricular fibrillation (VF). Severe symptoms occurred in 16/32 athletes (50%) during sports activity in 13/16 (81%): presyncope in nine (non-sustained VT in one, sustained VT in eight); syncope in five (sustained VT); aborted sudden death (SD) in one, SD (follow-up) in one. The reproducibility (HM, ST, EES) of clinically severe arrhythmic manifestations which occurred during sports activity was not high. In fact, during sport many factors are at work which may activate several arrhythmogenic mechanisms not easily reproducible in the laboratory. We conclude that a cardioarrhythmological study is mandatory in suspected right ventricular arrhythmias, including morphological study of the RV, to avoid arrhythmic risk during athletic activity.

Five nurses have been investigated for the two nights of a rapidly rotating shift schedule on four occasions: once with normal ward lighting (40 lux on average) and three times while wearing a light visor (Bio-Brite Inc., MD, USA). The visor was worn for four periods of 40 minutes each, at about 2 hour intervals during each night shift, the intensity giving 400-600, 1500 and 3200 lux for the three studies. The nurses recorded subjective evaluations of mood, physical fitness, sleepiness and fatigue, and carried out some performance measures (Simple Auditory Reaction Time, Flicker Fusion Frequency, Search and Memory test) at the start, middle and end of each night shift. Plasma cortisol was measured at the end of the shift, and 6-sulphatoxymelatonin was measured in urine collected at the middle and end of each shift. Oral temperature was also recorded for 48 h covering the two shifts.No significant effects of light treatment (even at 3200 lux) upon within-shift decline in mood and performance were seen. The acceptability of the wearer of the visor was moderate since the upper visual field was impaired and, at the highest light intensity, there was difficulty in seeing clearly objects in the dimly-lit environment. Furthermore, no significant falls in melatonin excretion and cortisol excretion were noted, but there was some evidence that the circadian rhythm of oral temperature was stabilised by the light visors. This is thoroughly desirable in rapidly rotating shift systems.

No abstract

Some supraventricular tachyarrhythmias (SVT), particularly if paroxysmal and/or related to Wolff-Parkinson-White syndrome (WPW), may in some cases endanger an athlete's professional career due to hemodynamic consequences during athletic activity, which in some instances may be life-threatening. One must also take into account that in Italy the law makes antiarrhythmic drug treatment (AAD) incompatible with sport eligibility. For these reasons, the utilization of radiofrequency ablation (RFA) in athletes has different indications as opposed to the normal population, since the primary goal is "the eligibility of the athlete." In our study, we discuss the criteria for indication of RFA in athletes with SVT on the basis of the data obtained from our population of athletes, studied over a 20-year period, from 1974 to the 31st of December 1993. These athletes were evaluated for arrhythmic events, utilizing a standardized cardioarrhythmological protocol: 1,325 athletes (1,125 men, 200 women, mean age 20.7 years). One subgroup included 380 athletes with WPW (28.7%), 22 athletes with aborted sudden death (1.6%), 6 of whom had WPW, 13 athletes with sudden death (0.98%), and 2 of whom had WPW. Another subgroup was formed by 116 top level elite professional athletes (TLA) (mean age 22.9 years), of which 10 of 116 (8.6%) had WPW and 12 of 116 (10.3%) had paroxysmal SVT. The most important indications for RFA in athletes are represented by: WPW asymptomatic at risk, symptomatic during athletic activity, and/or requiring AAD treatment: paroxysmal junctional reentrant tachycardia: when this condition is disabling and related to exercise and therefore compromising an athlete's performance and sports career. Paroxysmal junctional reentrant tachycardia is easily reproduced via transesophageal atrial pacing (TAP) during exercise (bicycle ergometer), common in athletes but normally the recurrences are concentrated only during the period in which the athlete is engaged in sport. Rare indications for RFA are focal or reentry, permanent SVT, and particularly junctional reentrant tachycardia. For each individual athlete, we have to consider the possible side-effects of RFA, the possible recurrences with psychobiological traumatic consequences, the effective recovery period, and the natural history of the tachyarrhythmias, which frequently disappear after interruption of the sports career.