Since the early 80s’, competitive Italian athletes must undergo annual pre-participation screening to detect cardiovascular conditions at risk of sudden cardiac death. Strange and rare ECG pictures may be observed. Premature beats, whether isolated or repetitive, are the most common arrhythmic events and can be very easy to diagnose, but sometimes difficult to interpret. Atrial and ventricular extrasystoles account for most of them, while arrhythmias originating from the specialized conduction system other than the left bundle fascicles are rare and mostly unrecognized.
In young competitive athletes, ventricular arrhythmias could be a reason for concern as they may represent the sign of a serious underlying cardiac condition. On the other hand, atrial or conduction system premature beats are usually benign. However, when the properties of the His-Purkinje system lead to conduction aberrancies, there is a risk of misinterpreting benign arrhythmias (such as premature atrial beats) as potentially at-risk ventricular ectopic beats.
An asymptomatic 15 year-old soccer player with unremarkable past medical and familial history had undergone the annual pre-participation screening. Resting ECG revealed brief paroxysms of asymptomatic tachycardia featured by the alternation of narrow and wide QRS complexes with both right-bundle-branch (RBBB) and left-bundle-branch-block (LBBB) morphologies. He was then referred to the Cardiology Unit for further evaluation.
The references are available in the explanation text of the MCQs in the quiz.
Authors information:
Nicolò Martini1 MD, Bortolo Martini2 MD, Domenico Corrado1 MD PhD, Alessandro Zorzi1 MD PhD
1) Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
2) Cardiac Unit, Alto Vicentino Hospital, Santorso, Italy, (retired)
