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MEDICINA DELLO SPORT
A Journal on Sports Medicine
Official Journal of the Italian Sports Medicine Federation
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,163
Medicina dello Sport 1999 September;52(3):183-90
Ventricular tachyarrhythmias: ECG patterns and electrophysiological mechanisms
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.