Prolonged QT Interval in Athletes: Distinguishing between Pathology and Physiology

Christou, Georgios A; Vlahos, Antonios P.; Mantzoukas, Stefanos; Drougias, Chronis A; Christodoulou, Dimitrios

doi:10.1159/000526385

Cited by 7 publications

(6 citation statements)

References 60 publications

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“…Detailed evaluation revealed resting or exercise-induced atrial or ventricular arrhythmias or significant ST-T changes (ST-depression, T-wave inversion) in 8 (4.8%) athletes, while no pathological resting or exercise induced corrected QT interval changes (calculated by the Bazett formula) were found in any of the athletes 25 . In these cases, no direct connection between ECG abnormalities and the infection were proven, but further evaluation and close follow-up were recommended to exclude any potentially malignant arrhythmias or cardiac pathologies.…”

Section: Resultsmentioning

confidence: 93%

“…A detailed questionnaire was implemented to record the data of SARS-CoV-2 infection and sport activity. The severity of the acute infection was classified in accordance with the recommendations of Löllgen H et al 22 Following physical examination and blood pressure measurement (Omron M6 Comfort, OMRON Healthcare Group, Japan), 12-lead ECG (CardioSoft PC, GE Healthcare, Finland) was recorded in a resting, laying position and analysed according to the current guidelines 23 – 25 . Cardiac necroenzyme levels were measured from blood samples (cobas e 411 analyzer, ROCHE Hungary Ltd, Hungary; Elecsys Troponin T hs, Roche Diagnostics International AG, Switzerland 26 ).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Cardiopulmonary examinations of athletes returning to high-intensity sport activity following SARS-CoV-2 infection

Babity

Zámodics

König

et al. 2022

Sci Rep

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After SARS-CoV-2 infection, strict recommendations for return-to-sport were published. However, data are insufficient about the long-term effects on athletic performance. After suffering SARS-CoV-2 infection, and returning to maximal-intensity trainings, control examinations were performed with vita-maxima cardiopulmonary exercise testing (CPET). From various sports, 165 asymptomatic elite athletes (male: 122, age: 20y (IQR: 17-24y), training:16 h/w (IQR: 12–20 h/w), follow-up:93.5 days (IQR: 66.8–130.0 days) were examined. During CPET examinations, athletes achieved 94.7 ± 4.3% of maximal heart rate, 50.9 ± 6.0 mL/kg/min maximal oxygen uptake (V̇O2max), and 143.7 ± 30.4L/min maximal ventilation. Exercise induced arrhythmias (n = 7), significant horizontal/descending ST-depression (n = 3), ischemic heart disease (n = 1), hypertension (n = 7), slightly elevated pulmonary pressure (n = 2), and training-related hs-Troponin-T increase (n = 1) were revealed. Self-controlled CPET comparisons were performed in 62 athletes: due to intensive re-building training, exercise time, V̇O2max and ventilation increased compared to pre-COVID-19 results. However, exercise capacity decreased in 6 athletes. Further 18 athletes with ongoing minor long post-COVID symptoms, pathological ECG (ischemic ST-T changes, and arrhythmias) or laboratory findings (hsTroponin-T elevation) were controlled. Previous SARS-CoV-2-related myocarditis (n = 1), ischaemic heart disease (n = 1), anomalous coronary artery origin (n = 1), significant ventricular (n = 2) or atrial (n = 1) arrhythmias were diagnosed. Three months after SARS-CoV-2 infection, most of the athletes had satisfactory fitness levels. Some cases with SARS-CoV-2 related or not related pathologies requiring further examinations, treatment, or follow-up were revealed.

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Section: Resultsmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Cardiopulmonary examinations of athletes returning to high-intensity sport activity following SARS-CoV-2 infection

Babity

Zámodics

König

et al. 2022

Sci Rep

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“…The QTc values may change in both physiological and pathological conditions. Chronic exercise training in athletes has been associated with longer QT interval, whereas quitting exercise has been related to normalization of ECG with reappearance of repolarization abnormalities after beginning of exercise training ( Christou et al, 2022 ). QT prolongation in athletes has been linked with decreased QT dispersion and thus diminished arrhythmic potential, implying the benign nature of this physiological adaptation to chronic exercise training ( Stolt et al, 1999 ).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of electrocardiographic parameters in amputee football players

Kurtoğlu,

Akgümüş

et al. 2023

Front. Psychol.

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ObjectiveThe present study aimed to compare electrocardiographic (ECG) parameters of amputee football players (AF) with football players without disability (FP) and sedentary individuals without disability (SI).MethodsA total of 32 participants (AF = 9, FP = 11, SI = 12) were included in the study. ECG parameters including P-wave amplitude, P-wave duration, PR interval, QRS duration, RR interval, QT interval, corrected-QT interval (QTc), ST segment duration, Tp-e duration, Tp-e/QT and Tp-e/QTc ratios were assessed in all the study participants by using a 12-lead ECG device. OneWay ANOVA Test was used for statistical analysis.ResultsOf all ECG parameters, P-wave amplitude and QTc were significantly higher in the AF group in comparison to FP and SI groups. QRS duration was found to be lower in the AF group when compared to FP and SI groups. Myocardial repolarization parameters including Tp-e duration, Tp-e/QT and Tp-e/QTc ratios were similar between groups, as were other parameters such as P-wave duration, PR interval, RR interval, QRS duration and QT interval.ConclusionIt was found that some ECG parameters of amputee football players differ from those with non-disabled players and non-disabled sedentary individuals. These different parameters were within normal limits.

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“…Electrocardiographic measurements included heart rate, PR interval, QRS duration, QT interval, and QRS axis. Bazett's formula was used for calculation of corrected QT [10]. A second electrocardiogram was performed in 52 individuals (34 men and 18 women) after deep inspiration breath-hold for some seconds.…”

Section: Electrocardiographymentioning

confidence: 99%

“…These considerations are particularly important in athletes, since the possibility of chronic exercise-related electrocardiographic patterns should always be taken into account [8]. Even more, athletic activity poses an additional risk of sudden cardiac death in individuals with concealed cardiac disease, mandating a low threshold for extensive diagnostic evaluation in case of suspicious electrocardiographic patterns [9,10].…”

Section: Introductionmentioning

confidence: 99%

Physiological Changes in QRS Fragmentation in Athletes and Nonathletes without Cardiac Disease

Christou,

Christou

et al. 2024

JCM

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QRS fragmentation has not been linked with increased mortality in individuals without known cardiac disease. We aimed to investigate the physiological determinants of QRS fragmentation in individuals without cardiac disease. Methods: Study participants were 163 (54 athletes, 109 nonathletes) asymptomatic individuals with QRS fragmentation but without cardiac disease. QRS fragmentation was assessed in the supine position after deep inspiration or standing up and during exercise. The changes in QRS fragmentation were evaluated over a median follow-up period of 2.3 (0.8–4.9) years. Results: The most common lead with QRS fragmentation was III (63.0% in athletes, 61.5% in nonathletes), immediately followed by V1 (50.0%) and aVF (42.6%) in athletes and aVF (55.0%) in nonathletes. QRS fragmentation in V1 was more frequent in athletes compared to nonathletes (p < 0.001). Among athletes, the presence of QRS fragmentation in V1 could be independently predicted by increased RVOTproxi (right ventricular outflow tract proximal diameter indexed to body surface area) (p < 0.001). Among individuals with QRS fragmentation in V1, deep inspiration resulted in disappearance of QRS fragmentation more frequently in nonathletes compared to athletes (100% vs. 20%, p = 0.003). Deep inspiration resulted in disappearance of QRS fragmentation in aVF (p < 0.001). The presence of QRS fragmentation in II or aVF was associated with increased body mass index (BMI) (p = 0.003). Among athletes without QRS fragmentation in V1 at baseline, the appearance of QRS fragmentation in V1 at the end of follow-up was associated with greater training age (p = 0.034). Among individuals with QRS fragmentation in aVF at baseline, the disappearance of QRS fragmentation in aVF at the end of follow-up was associated with greater reduction in BMI (p = 0.008). Conclusions: The characteristic feature of QRS fragmentation in athletes was the presence of QRS fragmentation in V1, which was associated with RVOTproxi. The persistence of QRS fragmentation in V1 after deep inspiration could serve as a specific marker of exercise-training-related cardiac adaptation. The presence of QRS fragmentation in the leads of the frontal plane was influenced by BMI and respiration phase.

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Prolonged QT Interval in Athletes: Distinguishing between Pathology and Physiology

Cited by 7 publications

References 60 publications

Cardiopulmonary examinations of athletes returning to high-intensity sport activity following SARS-CoV-2 infection

Cardiopulmonary examinations of athletes returning to high-intensity sport activity following SARS-CoV-2 infection

Evaluation of electrocardiographic parameters in amputee football players

Physiological Changes in QRS Fragmentation in Athletes and Nonathletes without Cardiac Disease

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