Clinical and Prognostic Significance of Idiopathic Left Bundle-Branch Block in Young Adults.

AIMS: LBBB is rare in healthy young adults, and its long-term prognosis is uncertain. METHODS: 56 subjects (aged <50 years), in whom an LBBB was discovered by chance in the absence of clinical and echocardiographic evidence of heart disease, were collected in a multicenter registry. RESULTS: 69% were males. Mean age at the time of discovery of LBBB was 37 ± 11 years. Mean QRS duration was 149 ± 17 m sec and 35% had left axis deviation. All patients had a normal echocardiogram, except for left ventricular dyssynchrony; 37 patients underwent coronary angiography (30) or myocardial scintigraphy during effort Eriksson and Wilhelmsen (2005), and in all cases obstructive coronary artery disease was excluded. In 2/30 patients who underwent coronary angiography, an anomalous origin of the CX artery from the right coronary sinus was found. Thirty patients underwent cardiac magnetic resonance; in 60% it was normal, while in 40% it revealed late enhancement, which in 33% was localized in the basal septum, suggesting fibrosis of the left bundle branch. During follow-up (12+/10 years, median 10 years) no sudden death occurred. At the end of follow-up, all patients were alive, except for one who suffered accidental death. Two patients (3.5%) underwent PM implantation owing to syncope. The echocardiogram at the end of follow-up revealed LV dysfunction in only one patient. CONCLUSIONS: In young adults without apparent heart disease, LBBB is a heterogeneous condition. In the vast majority of cases, the prognosis is good and no ventricular dysfunction occurs over time. However, as only 18% of our patients were aged >60 years at the end of follow-up, we cannot establish the prognosis in older age-groups.

Long-term effect of continuing sports activity in competitive athletes with frequent ventricular premature complexes and apparently normal heart.

The long-term outcome of athletes with frequent ventricular premature complexes (VPCs) and apparently normal heart has not been fully clarified. To evaluate the clinical and prognostic significance of VPCs and the influence of continuing sports activity during follow-up, we studied 120 healthy athletes (96 men; median age 16 years) in whom frequent VPCs (>100 VPCs/24 hours) were discovered by chance during preparticipation screening. All athletes were followed up for a median of 84 months. During follow-up, 96 underwent serial 24-hour Holter recording and 62 underwent serial echocardiography. The median number of VPCs/24 hours on basal Holter was 3,760. During follow-up, 81 athletes continued sports activity, whereas 39 did not. No athlete died or developed overt heart disease. The median number of VPCs/24 hours decreased in both athletes who continued sports activity and those who did not (from 3,805 to 1,124, p <0.0001 and from 5,787 to 1,298, p <0.0001, respectively). During follow-up, left ventricular ejection fraction slightly decreased to <55% in 9 of 62 athletes who, in respect to the remaining 53, had more VPCs/24 hours both in the basal state (12,000 vs 3,880) and during follow-up (10,702 vs 1,368), and a longer follow-up (95 vs 36 months). In conclusion, (1) frequent VPCs in athletes without heart disease have a long-term benign prognostic significance, (2) sporting activity does not modify this benign outcome, (3) during follow-up, the burden of VPCs decreases whether or not subjects continue sports activity, and (4) in 14.5% of athletes, ejection fraction slightly decreases over time.

Influence of training on the number and complexity of frequent VPBs in healthy athletes.

OBJECTIVE: Frequent ventricular premature beats (VPBs) may be discovered during preparticipation screening in asymptomatic apparently healthy athletes. Some authors hypothesize that they may be a manifestation of 'athlete's heart' and suggest a deconditioning period, which should document a regression of arrhythmias, to exclude a concealed disease. METHODS: To test this hypothesis, we analysed 87 asymptomatic healthy athletes with frequent VPB (>100/24 h). Of these, 44 (group D) underwent at least 3 months' detraining, whereas 43 (group C) continued sporting activity. Athletes underwent 24-h Holter monitoring at the baseline after 5.2 ± 4 (group D) and 7.2 ± 5 (group C) months. RESULTS: Basal characteristics were similar in both groups. Comparison of the basal and follow-up Holter results revealed no significant difference in the mean number of VPB/24 h in either group. In group D, the number of VPB/24 h declined from 8126 ± 8129 to 7998 ± 10 976 (P = 0.48), whereas in group C it rose from 6027 ± 6374 to 6600 ± 8590 (P = 0.51). VPB either disappeared or were markedly reduced (<100 VPB/24 h) in 2/44 (4.5%) group D and 4/43 (9%) group C athletes.In neither group did the number of couplets or nonsustained ventricular tachycardia change significantly. CONCLUSION: In healthy athletes, frequent VPBs discovered by chance during preparticipation screening may not be a manifestation of 'athlete's heart', but may depend on other causes; in the latter case screening may simply reveal a pre-existing asymptomatic phenomenon; the usefulness of detraining in ascertaining eligibility for sport should be further investigated.

[Sensitivity and specificity of first-level screening in the identification of patients at risk for sudden cardiac death]. / Sensibilità e specificità dello screening di primo livello nell'individuazione delle patologie a rischio di morte improvvisa.

Since 1971, in Italy every citizen engaged in competitive sports activity must periodically undergo preventive medical examinations to ascertain eligibility for sports participation. The medical examination includes rest and effort ECG. The Italian model has a very good sensitivity in identifying most pathologies at risk of sudden death particularly in the young (hypertrophic cadiomyopathy, arrhythmogenic right ventricular disease, chanelopathies). In this model, the ECG is very important, being able to disclose cardiac anomalies in most cases. The application of the Italian screening model has progressively reduced the incidence of sudden death in athletes.