Ventricular arrhythmias in competitive athletes: risk stratification with T-wave alternans

Abstract

Introduction: Aim of our study is to evaluate the role of TWA to stratify the risk of sudden cardiac death in athletes (Ath) with complex ventricular arrhythmias (VA), and to document a possible correlation between TWA and electrophysiological testing (EES) results.

Methods: We studied 43 Ath with VA (31 M, mean age 34 ± 12 years). In all cases a cardiological evaluation was performed, including TWA and EES. The patients were evaluated during a follow-up of 25 ± 22 months. The end-point was the occurrence of sudden death or malignant ventricular tachyarrhythmias (VT).

Results: TWA was negative in 28 Ath (65%), positive in 8 (19%) and indeterminate in 7 (16%). All subjects with negative TWA did not show induction of VT at EES, with significant correlation between negative TWA and negative EES (p<0.001). All Ath with positive TWA also had VT induced by a EES, but without significant correlation between positive TWA and positive EES. In 2 Ath with undetermined TWA (29%) VT were induced at EES. Our data did not show significant correlation between indeterminate TWA and positive or negative EES. However, logistic regression analysis showed significant correlation between abnormal TWA test (positive or indeterminate) and inducibility of VT at EES (p<0.001). During follow-up we observed a significant difference in end-point occurrence between Ath with negative or positive TWA and between Ath with negative or positive EES.

Conclusion: TWA confirm its role as a simple and non-invasive test, and it seems useful for prognostic stratification of Ath with VA.

Keywords: Sport activity; Sudden death; T-wave alternans; Ventricular arrhythmias.

Fig. 1

- Results of TWA test and EES and occurrence of spontaneous ventricular arrhythmias during follow-up in study population. In brackets it is specified the number of patients who received ICD.

Fig. 2

- Positive TWA test in a 23-year-old male athlete with ventricular arrhythmias.

Fig. 3

- Induction of VF during programmed ventricular stimulation (double extrastimulus) in the same patient of Figure 2.

Fig. 4

- Kaplan-Meier survival curves comparing end-point occurrence between patients with negative, indeterminate and positive TWA.

Fig. 5

- Kaplan-Meier survival curves comparing end-point occurrence between patients with negative and positive EES.