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Electrocardiographic abnormalities of elite veteran athletes
J. ELECTROCARDIOLOGY
20(l),
1987,70-79
SELECTEWI;%TRACTS THIRTEENTH INTERNATIONAL CONGRESS ON ELECTROCARDIOLOGY and the 27th InternationalSymposium on Vectorcardiography Session Bl: Hypertrophy
Session Al : Pediatric Electrocardiography (Al-2) ECG Changes Following Percutaneous Balloon Dilatation of Pulmonic Stenosis P. Syamasundar Rao, Department of Pediatrics, King Faisai Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. The purpose of this paper was to study the ECG changes following balloon dilatation (BD) of pulmonic stenosis (PS) and to see if such changes reflect improvement in pulmonary valve gradient following BD. Twenty-two patients, aged 4 months to 20 years, underwent BD for severe valvar PS. In fifteen of these patients, ECGs were available 6 to 28 months (mean 14) following BD and were compared with pre-BD ECGs. it was noted that frontal plane mean QRS vector moved towards the left, from 121*26O to 731t32 (p cO.OOl), as did the horizontal plane mean QRS vector, 77&18” to 45f35 (p qO.02). The amplitude of R wave in V3R, 15.3k10.9 mm, and Vl, 23.2f17, decreased respectively to 10.9f4.4 and 11.2f4.4 (p
Diagnostic
(Bl-3)Eiectrocardiographic Veteran Athletes
Criteria
- Ventricular
Abnormalities
of Elite
Stuart D. Pringle, Peter W. Macfarlane, Francis G. Dunn, A. Ross Lorimer. University Department of Medical Cardiology, Royal Infirmary, Glasgow, Scotland. Electrocardiography (ECG) and echocardiography (echo) were used in a group of veteran athletes to determine whether cardiac adaptation to repetitive exercise in middle-aged subjects results in similar EGG and echo changes as in their younger counterparts. The study group comprised 30 elite veteran athletes (15 cyclists, 15 marathon runners), with mean age 54.2 years (range 42-72 years). Findings: Sinus bradycardia (<60/min) 24 (80%) First Degree Heart Block 3 (10%) Second Degree Heart Block (Type I) 1 (3%) Prolonged QTc (~0.46 sets) 4 (13%) ST elevation 7 (23%) Inverted T (So. 1 mv) 4 (13%) (1 anteroseptal), 1 anterolateral, 2 inferolateral). ECG criteria for left ventricular hypertrophy (LVH) did not correlate well with echo LVH which was present in 22 subjects (73%); SVl+RV5 > 3.5mV in 10 athletes i.e. Sensitivity 32%, Specificity 62.5%. Tallest R + Deepest S > 4.0mV in 16 athletes; i.e. Sensitivity 50%, Specificity 37.5. Conclusions: ECG abnormalities are common in elite veteran athletes. Accepted diagnostic ceiteria for ECG-LVH do not appear to be applicable to athletes’ hearts.
(Al-6) Evaluation of a New Adaptive Automatic Scanning Extrastimulus Antitachycardia Pacemaker in Children
(Bl-6) Left Ventricular Hypertrophy By ECG - How Important is the Underlying Disease?
Stanley D. Beder, Mark H. Cohen, Jerome Liebman. Rainbow Babies and Chiidrens Hospital, Case Western Reserve University, Cleveland, Ohio. An ever-increasing number of children undergo and survive surgery for complex congenital heart disease and may present with symptomatic postoperative tachyarrhythmias. Between April 1984 and May 1985, we performed acute evaluation of an external extrastimulus antitachycardia pacemaker during routine eiectrophysiologic study on 7 patients, age 2 to 30 years (median 14 years). Sustained atrial flutter (AF) (3 patients) or reciprocating supraventricular tachycardia (SVT) (4 patients) was easily and reproducibly induced during these studies. The cycle length of AF was 200 msec in each case and the cycle length of SVT ranged from 190 to 370 msec. Successful tachycardia conversion was achieved in each patient with SVT but in none of the patients with AF. In no case did the antitachycardia device accelerate or degenerate the patient’s arrhythmia. We conclude that extrastimulus antitachycardia pacing appears to be successful and safe in the acute setting. However, further data in a much larger number of children must be collected and analyzed before it can be determined if devices with this mode of tachycardia conversion are appropriate for implantation in children.
M. Fiuza, M.A. Turkman, T.C. Ferreira, A. Pereirinha, F. de Padua and M.G. Lopes. Centro Cardioiogia (CCUL) and Centro Estatistica (CEAUL) Universidade Lisboa, Portugal. To assess the importance of underlying heart disease in the sensitivity of Sokolow(S) and Casale(C) (JACC 6:572, 1985) criteria for left ventricular hypertrophy (LVH) 200 patients (pts) (146 M, 54 F, mean age: 54f13) with LVH by Echocardiography were studied. Six cardiac conditions were considered: Hypertension (HT; n=46); IHSS (HC; n=32); Aortic stenosis (AS; n=22); Aortic Regurgitation (AR; n=42); Dilated Cardiomyopathy (DC; n=21); Myocardial Infarction (Ml; n=37). Table shows the results in percentages: ECG CRITERIA HT HC AS AR DM MI TOTAL Sokolow (only) 9 13 9 24 5 11 13 33 31 14 19 Casale (only) 33 35 28 Sokolow+Casale 52 44 64 45 33 0 39 Sokolow (Total) 61 56 73 69 38 11 52 Casale (Total) 85 75 77 64 67 35 67 Overall sensitivity was 52% for S’s vs 67% for C’s (p
70
20(l),
1987,70-79
SELECTEWI;%TRACTS THIRTEENTH INTERNATIONAL CONGRESS ON ELECTROCARDIOLOGY and the 27th InternationalSymposium on Vectorcardiography Session Bl: Hypertrophy
Session Al : Pediatric Electrocardiography (Al-2) ECG Changes Following Percutaneous Balloon Dilatation of Pulmonic Stenosis P. Syamasundar Rao, Department of Pediatrics, King Faisai Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. The purpose of this paper was to study the ECG changes following balloon dilatation (BD) of pulmonic stenosis (PS) and to see if such changes reflect improvement in pulmonary valve gradient following BD. Twenty-two patients, aged 4 months to 20 years, underwent BD for severe valvar PS. In fifteen of these patients, ECGs were available 6 to 28 months (mean 14) following BD and were compared with pre-BD ECGs. it was noted that frontal plane mean QRS vector moved towards the left, from 121*26O to 731t32 (p cO.OOl), as did the horizontal plane mean QRS vector, 77&18” to 45f35 (p qO.02). The amplitude of R wave in V3R, 15.3k10.9 mm, and Vl, 23.2f17, decreased respectively to 10.9f4.4 and 11.2f4.4 (p
Diagnostic
(Bl-3)Eiectrocardiographic Veteran Athletes
Criteria
- Ventricular
Abnormalities
of Elite
Stuart D. Pringle, Peter W. Macfarlane, Francis G. Dunn, A. Ross Lorimer. University Department of Medical Cardiology, Royal Infirmary, Glasgow, Scotland. Electrocardiography (ECG) and echocardiography (echo) were used in a group of veteran athletes to determine whether cardiac adaptation to repetitive exercise in middle-aged subjects results in similar EGG and echo changes as in their younger counterparts. The study group comprised 30 elite veteran athletes (15 cyclists, 15 marathon runners), with mean age 54.2 years (range 42-72 years). Findings: Sinus bradycardia (<60/min) 24 (80%) First Degree Heart Block 3 (10%) Second Degree Heart Block (Type I) 1 (3%) Prolonged QTc (~0.46 sets) 4 (13%) ST elevation 7 (23%) Inverted T (So. 1 mv) 4 (13%) (1 anteroseptal), 1 anterolateral, 2 inferolateral). ECG criteria for left ventricular hypertrophy (LVH) did not correlate well with echo LVH which was present in 22 subjects (73%); SVl+RV5 > 3.5mV in 10 athletes i.e. Sensitivity 32%, Specificity 62.5%. Tallest R + Deepest S > 4.0mV in 16 athletes; i.e. Sensitivity 50%, Specificity 37.5. Conclusions: ECG abnormalities are common in elite veteran athletes. Accepted diagnostic ceiteria for ECG-LVH do not appear to be applicable to athletes’ hearts.
(Al-6) Evaluation of a New Adaptive Automatic Scanning Extrastimulus Antitachycardia Pacemaker in Children
(Bl-6) Left Ventricular Hypertrophy By ECG - How Important is the Underlying Disease?
Stanley D. Beder, Mark H. Cohen, Jerome Liebman. Rainbow Babies and Chiidrens Hospital, Case Western Reserve University, Cleveland, Ohio. An ever-increasing number of children undergo and survive surgery for complex congenital heart disease and may present with symptomatic postoperative tachyarrhythmias. Between April 1984 and May 1985, we performed acute evaluation of an external extrastimulus antitachycardia pacemaker during routine eiectrophysiologic study on 7 patients, age 2 to 30 years (median 14 years). Sustained atrial flutter (AF) (3 patients) or reciprocating supraventricular tachycardia (SVT) (4 patients) was easily and reproducibly induced during these studies. The cycle length of AF was 200 msec in each case and the cycle length of SVT ranged from 190 to 370 msec. Successful tachycardia conversion was achieved in each patient with SVT but in none of the patients with AF. In no case did the antitachycardia device accelerate or degenerate the patient’s arrhythmia. We conclude that extrastimulus antitachycardia pacing appears to be successful and safe in the acute setting. However, further data in a much larger number of children must be collected and analyzed before it can be determined if devices with this mode of tachycardia conversion are appropriate for implantation in children.
M. Fiuza, M.A. Turkman, T.C. Ferreira, A. Pereirinha, F. de Padua and M.G. Lopes. Centro Cardioiogia (CCUL) and Centro Estatistica (CEAUL) Universidade Lisboa, Portugal. To assess the importance of underlying heart disease in the sensitivity of Sokolow(S) and Casale(C) (JACC 6:572, 1985) criteria for left ventricular hypertrophy (LVH) 200 patients (pts) (146 M, 54 F, mean age: 54f13) with LVH by Echocardiography were studied. Six cardiac conditions were considered: Hypertension (HT; n=46); IHSS (HC; n=32); Aortic stenosis (AS; n=22); Aortic Regurgitation (AR; n=42); Dilated Cardiomyopathy (DC; n=21); Myocardial Infarction (Ml; n=37). Table shows the results in percentages: ECG CRITERIA HT HC AS AR DM MI TOTAL Sokolow (only) 9 13 9 24 5 11 13 33 31 14 19 Casale (only) 33 35 28 Sokolow+Casale 52 44 64 45 33 0 39 Sokolow (Total) 61 56 73 69 38 11 52 Casale (Total) 85 75 77 64 67 35 67 Overall sensitivity was 52% for S’s vs 67% for C’s (p
70