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Normalization of T-wave inversion in children practising sport: a prospective, 4-year follow-up study.

Session Young investigator award session I - Sport Cardiology

Speaker Assistant Professor Flavio D'Ascenzi

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2018

  • Topic : arrhythmias and device therapy
  • Sub-topic : Arrhythmias, General – Other
  • Session type : Young Investigator Award Abstracts

Authors : F D'ascenzi (Siena,IT), F Anselmi (Siena,IT), B Berti (Siena,IT), A Franchini (Siena,IT), E Capitani (Siena,IT), F Graziano (Siena,IT), M Focardi (Siena,IT), M Capitani (Siena,IT), M Bonifazi (Siena,IT), S Sharma (London,GB), D Corrado (Padova,IT), S Mondillo (Siena,IT)

Authors:
F D'ascenzi1 , F Anselmi1 , B Berti2 , A Franchini2 , E Capitani1 , F Graziano1 , M Focardi1 , M Capitani3 , M Bonifazi2 , S Sharma4 , D Corrado5 , S Mondillo1 , 1University of Siena, Department of Medical Biotechnologies, Division of Cardiology - Siena - Italy , 2University of Siena, Department of Medicine, Surgery, and NeuroScience - Siena - Italy , 3Center of Sports Medicine - Siena - Italy , 4St George's University of London - London - United Kingdom , 5Department of cardiac, thoracic and vascular sciences, University of Padua - Padova - Italy ,

Citation:
European Journal of Preventive Cardiology ( May 2018 ) 25 ( Supplement 1 ), 3

Background: Intense physical training is usually accompanied by electrical adaptations. While some ECG patterns are common in athletes and related to training, other ECG abnormalities, specifically T-wave inversion (TWI), are rare in athletes but are common manifestations in patients with cardiomyopathies. Although the prevalence and significance of TWI has been extensively investigated in adult athletes, little is known in the paediatric athletic populations TWI is common in children and it may occasionally persist during adolescence. Therefore, the interpretation of anterior TWI in children should be challenging.
Purpose: The aim of this study was to establish the prevalence of TWI in a large cohort of pre-adolescent athletes and to longitudinally follow children with TWI in order to evaluate when anterior TWI regresses over time.
Methods: We enrolled 2277 children practicing competitive sports. Subjects with complete RBBB, with repolarization abnormalities other than TWI or with TWI secondary to WPW syndrome were excluded from the study with a final population of 2227 athletes. All children underwent physical examination and 12-lead resting ECG. Children with TWI underwent yearly follow-up until the normalisation of TWI and for a maximum period of observation of 4 years.
Results: Among 2227 children, 358 (16%) had TWI. Children with TWI were significantly younger and had smaller BSA than those without TWI (p<0.001). Early repolarization in anterior leads was more frequent in children without TWI (p<0.0001). The great majority of children with TWI showed anterior TWI (97%) while only 3% showed TWI on the infero-lateral leads. Almost all the children with anterior TWI (94%) normalized during follow-up at a mean age of 13 years. Conversely, in children with infero-lateral TWI, only one (11%) child showed a complete positivisation and another one was found to have a cardiomyopathy (figure 1).
Conclusions: The prevalence of anterior TWI is common in children while infero-lateral TWI is rare. During the 4-year follow up, most of anterior TWI demonstrated an inversion of polarity before the age of 14 years. Conversely, the normalization of infero-lateral TWI was rare. Therefore, infero-lateral TWI should not be interpreted as physiologically related to age or training and should undergo a strict follow-up.

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