Electrocardiographic differentiation of idiopathic right ventricular outflow tract ectopy from early arrhythmogenic right ventricular cardiomyopathy

Novák, Jan; Zorzi, Alessandro; Castelletti, Silvia; Pantasis, Antonis; Rigato, Ilaria; Corrado, Domenico; McKenna, William J.; Lambiase, Pier D.

doi:10.1093/europace/euw018

Cited by 19 publications

(26 citation statements)

References 26 publications

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“…There also is evolving evidence that high-dynamic exercise sustained over a long period of time may result in ‘exercise-induced’ ARVC, even in the absence of desmosomal mutations or a familial history 143 149–151. PVCs originating from the right ventricular outflow tract conduct with LBBB and an inferior axis and are usually regarded as benign when associated with an otherwise normal ECG; however, this PVC morphology can also be present in patients with early ARVC particularly when the QRS exceeds 160 ms 152. In contrast, PVCs originating from the main body of the right ventricle typically show a LBBB pattern and superior axis (predominantly negative QRS vector in V1 and the inferior leads) and may be associated with right ventricular pathology particularly in the context of other ECG abnormalities (figure 20).…”

Section: Abnormal Ecg Findings In Athletesmentioning

confidence: 99%

International criteria for electrocardiographic interpretation in athletes: Consensus statement

et al. 2017

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Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.

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Section: Abnormal Ecg Findings In Athletesmentioning

confidence: 99%

International criteria for electrocardiographic interpretation in athletes: Consensus statement

et al. 2017

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“…Holter monitoring is a key test for the evaluation of the ‘arrhythmic burden’, that is, the number of PVBs during 24 hours and their tendency to form couplets, triplets or non-sustained ventricular tachycardia (VT). More than 500 PVBs per 24 hours on Holter monitoring may signal risk of SCD and is a diagnostic criterion for arrhythmogenic cardiomyopathy 22 23. However, frequent PVBs are associated with a benign prognosis if an underlying disease and tachycardia-mediated left ventricular dysfunction are excluded 11 24–28.…”

Section: Which Characteristics Of Pvbs Confer a Worse Prognosis?mentioning

confidence: 99%

How to evaluate premature ventricular beats in the athlete: critical review and proposal of a diagnostic algorithm

et al. 2019

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Although premature ventricular beats (PVBs) in young people and athletes are usually benign, they may rarely mark underlying heart disease and risk of sudden cardiac death during sport. This review addresses the prevalence, clinical meaning and diagnostic/prognostic assessment of PVBs in the athlete. The article focuses on the characteristics of PVBs, such as the morphological pattern of the ectopic QRS and the response to exercise, which accurately stratify risk. We propose an algorithm to help the sport and exercise physician manage the athlete with PVBs. We also address (1) which athletes need more indepth investigation, including cardiac MRI to exclude an underlying pathological myocardial substrate, and (2) which athletes can remain eligible to competitive sports and who needs to be excluded.

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“…Although these RVOT/LVOT arrhythmias usually occur in structurally normal hearts, they may rarely be an atypical expression of arrhythmogenic (right) ventricular cardiomyopathy. 156 The absence of imaging abnormalities on an echocardiogram and cardiac magnetic resonance imaging (MRI) can help to rule out structural heart disease in such patients. The demonstration of PVCs of differing morphologies from the right ventricle (RV) in patients with normal LV function should prompt investigations to rule out arrhythmogenic cardiomyopathy with right ventricular dominance or sarcoidosis.…”

Section: Consensus Statements Symbol Referencesmentioning

confidence: 99%

Management of asymptomatic arrhythmias: a European Heart Rhythm Association (EHRA) consensus document, endorsed by the Heart Failure Association (HFA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin America Heart Rhythm Society (LAHRS)

et al. 2019

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Asymptomatic arrhythmias are frequently encountered in clinical practice. Although studies specifically dedicated to these asymptomatic arrhythmias are lacking, many arrhythmias still require proper diagnostic and prognostic evaluation and treatment to avoid severe consequences, such as stroke or systemic emboli, heart failure, or sudden cardiac death. The present document reviews the evidence, where available, and attempts to reach a consensus, where evidence is insufficient or conflicting.

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Electrocardiographic differentiation of idiopathic right ventricular outflow tract ectopy from early arrhythmogenic right ventricular cardiomyopathy

Cited by 19 publications

References 26 publications

International criteria for electrocardiographic interpretation in athletes: Consensus statement

International criteria for electrocardiographic interpretation in athletes: Consensus statement

How to evaluate premature ventricular beats in the athlete: critical review and proposal of a diagnostic algorithm

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