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St George’s university of London, UK:Dr Nabeel Sheikh, Cardiology Research FellowDr Michael Papadakis, Lecturer in cardiologyProf Sanjay Sharma, Professor of clinical cardiologyon behalf of the EACPR Sports Cardiology Section.
A 17-year-old male athlete was referred for specialist investigation after an abnormal ECG on routine pre-participation cardiac evaluation. He had been participating in competitive exercise since the age of 12 years. His current regime consisted of swimming for 20 hours and cycling for 6 hours per week. He was asymptomatic. There was no past medical or family history of note. He denied recreational or performance enhancing drug use. Cardiac examination identified bradycardia of 40 beats per minute. The 12-lead ECG is shown below. A transthoracic echocardiogram revealed a structurally normal heart.
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For further reading:[*1] The enigmatic sixth wave of the electrocardiogram: the U wave. Pérez Riera AR, Ferreira C, Filho CF, Ferreira M, Meneghini A, Uchida AH, Schapachnik E, Dubner S, Zhang L. Cardiol. J. 2008; 15:408–21. [*2] Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists. Baldesberger S, Bauersfeld U, Candinas R, Seifert B, Zuber M, Ritter M, Jenni R, Oechslin E, Luthi P, Scharf C, Marti B, Attenhofer Jost CH. Eur. Heart J. 2008; 29:71–8. [*3] Second-degree atrioventricular block: a reappraisal. Barold S, Hayes D. Mayo Clin. Proc. 2001; 76:44–57. [*4] Second-degree atrioventricular block revisited. Barold SS, Herweg B. Herzschrittmacherther. Elektrophysiol. 2012; 23:296–304. [*5] Mobitz type II second-degree atrioventricular block in athletes: true or false? Barold SS, Padeletti L. Br. J. Sports Med. 2011; 45:687–90. [*6]Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists. Baldesberger S, Bauersfeld U, Candinas R, Seifert B, Zuber M, Ritter M, Jenni R, Oechslin E, Luthi P, Scharf C, Marti B, Attenhofer Jost CH. Eur. Heart J. 2008; 29:71–8.
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