Ionic Mechanisms and Vectorial Model of Early Repolarization Pattern in the Surface Electrocardiogram of the Athlete

Barbosa, Eduardo Corrêa; Bomfim, Alfredo de Souza; Benchimol-Barbosa, Paulo Roberto; Ginefra, P

doi:10.1111/j.1542-474x.2008.00235.x

Cited by 32 publications

(22 citation statements)

References 24 publications

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“…22 ERP can be thought of as an electrocardiographic signature of repolarization dispersion and can arise in numerous conditions including myocardial injury, 23 extremes of temperature such as hypothermia, local differences in I to current density, 24 and primary heritable disorders (e.g. mutations in KCNJ8 , 25 CACNA1C, CACNB2B , and CACNA2D1 26 ). In athletes, it has been proposed that parasympathetic modulation increases regional electrophysiological differences and repolarization dispersion resulting in ST elevation, J-waves, and prominent T-waves.…”

Section: Discussionmentioning

confidence: 99%

Early Repolarization Pattern in Competitive Athletes

Noseworthy

Weiner

Kim

et al. 2011

Circ: Arrhythmia and Electrophysiology

128

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Background Inferior lead early repolarization pattern (ERP) has recently been associated with sudden cardiac death. Although ERP is common among athletes, prevalence, ECG lead distribution, clinical characteristics, and effects of physical training remain uncertain. We sought to examine the non-anterior early repolarization pattern (ERP) in competitive athletes. Methods and Results ERP was assessed in a cross-sectional cohort of collegiate athletes (n=879). The relationship between ERP and cardiac structure were then examined in a longitudinal subgroup (n=146) before and after a 90-day period of exercise training. ERP was defined as J-point elevation ≥ 0.1 mV in at least two leads within a non-anterior territory (inferior [II, III, aVF] or lateral [I, aVL, V4-V6]). Non-anterior ERP was present in 25.1% (221/879) of athletes including the inferior subtype in 3.8% (33/879). Exercise training led to significant increases in the prevalence of ERP and the inferior subtype but there were no associations between ERP and echocardiographic measures of left ventricular remodeling. In a multivariable model, ERP was associated with black race (OR 5.84, CI 3.54-9.61, p<0.001), increased QRS voltage (OR 2.08, CI 1.71-2.52, p<0.001), and slower HR (OR 1.54, CI 1.26-1.87, p<0.001). Conclusions Non-anterior ERP including the inferior subtype are common and have strong clinical associations among competitive athletes. The finding of increased ERP prevalence following intense physical training establishes a strong association between exercise and the ERP.

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Section: Discussionmentioning

confidence: 99%

Early Repolarization Pattern in Competitive Athletes

Noseworthy

Weiner

Kim

et al. 2011

Circ: Arrhythmia and Electrophysiology

128

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“…18 In that report, subjects were not exposed to the mechanisms associated with competitive sport activity possibly precipitating CA in patients at risk. In addition, sport-induced rate-dependent repolarization inhomogeneities, 21 unknown mutations of ion channels regulating cardiac repolarization, and alterations of repolarization secondary to possible intake of illicit drugs 26 also may have been precipitating factors.…”

Section: Discussionmentioning

confidence: 99%

“…2,21 Whether such changes may be arrhythmogenic and ultimately lead to VF has not been systematically investigated. The aim of the present study was to assess whether QRS-ST-segment changes observed at baseline ECG may represent a marker of risk for cardiac arrest (CA) or sudden death (SD) in competitive athletes in the absence of heart disease.…”

Section: Clinical Perspective On P 311mentioning

confidence: 99%

J Wave, QRS Slurring, and ST Elevation in Athletes With Cardiac Arrest in the Absence of Heart Disease

Cappato

Furlanello

Giovinazzo

et al. 2010

Circ: Arrhythmia and Electrophysiology

102

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Background-QRS-ST changes in the inferior and lateral ECG leads are frequently observed in athletes. Recent studies have suggested a potential arrhythmogenic significance of these findings in the general population. The aim of our study was to investigate whether QRS-ST changes are markers of cardiac arrest (CA) of unexplained cause or sudden death in athletes. Methods and Results-In 21 athletes (mean age, 27 years; 5 women) with cardiac arrest or sudden death, the ECG recorded before or immediately after the clinical event was compared with the ECG of 365 healthy athletes eligible for competitive sport activity. We measured the height of the J wave and ST elevation and searched for the presence of QRS slurring in the terminal portion of QRS. QRS slurring in any lead was present in 28.6% of cases and in 7.6% of control athletes (Pϭ0.006). A J wave and/or QRS slurring without ST elevation in the inferior (II, III, and aVF) and lateral leads (V 4 to V 6 ) were more frequently recorded in cases than in control athletes (28.6% versus 7.9%, Pϭ0.007). Among those with cardiac arrest, arrhythmia recurrences did not differ between the subgroups with and without J wave or QRS slurring during a median 36-month follow-up of sport discontinuation. Conclusions-J wave and/or QRS slurring was found more frequently among athletes with cardiac arrest/sudden death than in control athletes. Nevertheless, the presence of this ECG pattern appears not to confer a higher risk for recurrent malignant ventricular arrhythmias. (Circ Arrhythm Electrophysiol. 2010;3:305-311.)

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“…34 This same alteration of ventricular repolarization by heightened vagal tone may also be the mechanism of increased T wave amplitude in the athlete heart. 35 The description of an association between early repolarization patterns and an increased risk of sudden cardiac death 40 makes differentiation of exercise-induced early repolarization from the variant associated with sudden death important to the clinician. The most effective way to differentiate may be to recognize that while early repolarization in the young athlete appears dynamically at times of peak fitness, the increased mortality associated with patterns of early repolarization appears to be confined to the fourth and fifth decades of life.…”

Section: Myocardial Adaptations To Exercisementioning

confidence: 99%