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Medicina dello Sport 2009 December;62(4):455-65


language: English, Italian

The Wolff-Parkinson-White syndrome: usefulness of the electrophysiological testing in the sportsman. A case report

Franculli F. 1, 2, D’Ascia S. L. 3, Liguori V. 3, Marino V. 3, Ar-turo C. 3, Argenziano L. 3, Pio A. 2, Capuano V. 1, D’Ascia C. 3

1 Operative Unit of Cardiology with Utic and Sports Medicine “Fucito” di Mercato San Severino Hospital, ASL SA/2, Salerno, Italy 2 Social and Sports Medicine Institute, Salerno Medical Sports Medicine, Salerno, Italy 3 Elettrophysiology and Elettrostimulation Laboratory, Department of Clinical Medicine, Cardiovascular and Immunological Sciences, “Federico II” Faculty of Medicine and Surgery, University of Naples, Naples, Italy


The Wolff-Parkinson-White syndrome (WPW) refers to coexisting ventricular pre-excitation and potentially fatal tachyarrhythmias. The electrocardiographic pattern consists of a short PR interval, a prolonged QRS complex with an abnormal polarization phase and a slurred initial component (delta wave). These electrocardiographic abnormalities are caused by electrical impulses bypassing the atrioventricular node over an accessory pathway between the atria and the ventricles. The estimate prevalence of the WPW pattern is 1.5:1 000 population. A 20-year-old woman with familial occurrence of WPW had been actively engaged in sports since the age of 12 years. Despite a diagnosis of the syndrome after level I cardiologic evaluation resulted negative for spontaneous or inducible tachyarrhythmias, she remained nearly completely asymptomatic. Recent preoperative cardiologic screening showed no evidence of arrhythmic events. Following repeated level I cardiologic evaluation, she was referred to a sports medicine physician for physical fitness certification. Although she practiced amateur sports, she underwent an electrophysiological study (EPS) with transesophageal pacing, which induced an episode of sustained preexcited atrial fibrillation (shortest RR 240 ms), followed by endocavitary EPS, with digital 3D reconstruction of the heart chambers (EnSite NavX system). A diagnosis of posteroseptal Kent bundle with epicardial extension was established and treated with radio-frequency catheter ablation. In all persons with the WPW syndrome, physical fitness certification for competitive sports must take into consideration findings from transesophageal EPS; in those with a history of symptomatic arrhythmias, further testing with endocavitary EPS should be performed before a certificate of sports fitness can be issued. We believe that, whatever the medicolegal implications, there is no difference between competitive and non-competitive sports in relation to cardiovascular effort.

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