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A Journal on Sports Medicine

Official Journal of the Italian Sports Medicine Federation
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Medicina dello Sport 1999 September;52(3):183-90

language: Italian

Ven­tric­ular tachyar­rhyth­mias: ECG pat­terns and elec­tro­phys­io­log­ical mech­a­nisms

Bonatti V.

UO Cardiologia - UTIC, Ospedale SS. Giacomo e Cristoforo - Massa


Ven­tric­ular tachyar­rhyth­mias, due to ­abnormal auto­ma­ticity, trig­gered ­activity, ­reentry, can ­occur in ­young ­people who prac­tise ­sport. Con­gen­ital or ­acquired ­heart dis­ease can be respon­sible for ­them. Anom­a­lous ­origin of cor­o­nary ­arteries or cor­o­nary ­spasm ­should be sus­pected ­when the arrhyth­mias are pre­ceded by epi­sodes of ­acute myo­car­dial ­ischemia. In gen­eral the pos­sibility of ­latent ­heart dis­ease (­some ­forms of hyper­trophic or ­dilated car­di­om­yo­pathy, myo­car­ditis, arrhyth­mo­genic ­right ven­tric­ular dys­plasia, ­should ­always be con­sid­ered and inves­ti­gated.
In ­moat ­cases, how­ever, the arrhyth­mias ­occur in sub­jects ­with ­normal ­heart. ­Idiopathic ­right ven­tric­ular tachyar­rhyth­mias, ­including extra­sys­toles and par­ox­ismal or repet­i­tive tach­y­cardia, ­have char­ac­ter­is­ti­cally a ­left ­bundle ­branch ­block and ­right ­axis devi­a­tion con­tour sug­gesting ­their ­origin ­from the ­right ven­tric­ular out­flow ­tract. ­They are trig­gered arrhyth­mias and ­most of ­them are ­benign. ­Their asso­ci­a­tion ­with ­right ven­tric­ular dys­plasia ­which can ­favour ­their trans­for­ma­tion ­into ­serious reen­trant arrhyth­mias ­should be sus­pected on ­some occa­sions. Elec­tro­phys­io­log­i­cally and clin­i­cally sim­ilar but ­less ­common ­idiopathic ­left ven­tric­ular tachyar­rhyth­mias, ­also ­called fasic­ular ven­tric­ular tachyar­rhyth­mias ­have char­ac­ter­is­ti­cally a ­right ­bundle ­branch ­block and ­left ­axis devi­a­tion con­tour sug­gesting ­their ­origin ­from the ­left ven­tric­ular out­flow ­tract. In ­young sub­jects ­with con­gen­ital ­long QT syn­dromes a typ­ical end ­well ­known ­arrhythmia can be ­found, the 90 ­called tor­sade de ­pointe ven­tric­ular tach­y­cardia. ­This is prob­ably a trig­gered ­arrhythmia ­which can some­times ­transorm ­into a ­very ­serious and pos­sibly ­lethal reen­trant ­arrhythmia. ­Also ­serious and pos­sibly ­lethal are ­some ­types of pol­i­mor­phic ven­tric­ular tach­y­cardia (reen­trant ­arrhythmia) occur­ring in ­young sub­jects ­without QT pro­lon­ga­tion: ­Brugada’s syn­drome and ­other sim­ilar syn­dromes are char­ac­ter­ized by arrhyth­mias of ­this ­type.

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