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A 16-year-old Caucasian national level cyclist…Deciphering the role of anterior T-wave inversion in young athletes

Sabiha Gati, Sports Cardiology Quiz Section Editor

Rehabilitation and Sports Cardiology


The case

A 16-year-old Caucasian national level cyclist underwent a cardiac evaluation organised by a charity organisation. He attended on a voluntary basis after a fellow cyclist suffered a sudden cardiac arrest during a race in 2013.

  • He was asymptomatic at the time and there was no relevant family history of premature cardiovascular disease or sudden cardiac death.
  • His ECG (Figure 1) showed sinus bradycardia with T-wave inversion in leads V1-V3, borderline prolonged S wave duration of 55 msec in V2 and the possibility of an Epsilon wave in lead V1. 

Figure 1: ECG 2013

 2019-07-case-ECG-figure1.JPG

 

 

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Note: The views and opinions expressed on this page are those of the author and may not be accepted by others. While every attempt is made to keep the information up to date, there is always going to be a lag in updating information. The reader is encouraged to read this in conjunction with appropriate ESC Guidelines. The material on this page is for educational purposes and is not for use as a definitive management strategy in the care of patients. Quiz material in the site are only examples and do not guarantee outcomes from formal examinations.

References

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  2. Lie OH, Dejgaard LA, Saberniak J, et al. Harmful Effects of Exercise Intensity and Exercise Duration in Patients With Arrhythmogenic Cardiomyopathy. JACC Clin Electrophysiol. 2018;4(6):744-753. doi:10.1016/j.jacep.2018.01.010.
  3. Ruwald A-C, Marcus F, Estes NAM 3rd, et al. Association of competitive and recreational sport participation with cardiac events in patients with arrhythmogenic right ventricular cardiomyopathy: results from the North American multidisciplinary study of arrhythmogenic right ventricular cardiomyopathy. Eur Heart J. 2015;36(27):1735-1743. doi:10.1093/eurheartj/ehv110.
  4. Saberniak J, Hasselberg NE, Borgquist R, et al. Vigorous physical activity impairs myocardial function in patients with arrhythmogenic right ventricular cardiomyopathy and in mutation positive family members. Eur J Heart Fail. 2014;16(12):1337-1344. doi:10.1002/ejhf.181.
  5. James CA, Bhonsale A, Tichnell C, et al. Exercise increases age-related penetrance and arrhythmic risk in arrhythmogenic right ventricular dysplasia/cardiomyopathy-associated desmosomal mutation carriers. J Am Coll Cardiol. 2013;62(14):1290-1297. doi:10.1016/j.jacc.2013.06.033.
  6. Corrado D, Pelliccia A, Heidbuchel H, et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J. 2010:243-259. doi:10.1093/eurheartj/ehp473.
  7. Marcus FI, McKenna WJ, Sherrill D, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation. 2010;121(13):1533-1541. doi:10.1161/CIRCULATIONAHA.108.840827.
  8. Finocchiaro G, Papadakis M, Dhutia H, et al. Electrocardiographic differentiation between “benign T-wave inversion” and arrhythmogenic right ventricular cardiomyopathy. Eur Eur pacing, arrhythmias, Card Electrophysiol  J  Work groups Card pacing, arrhythmias, Card Cell Electrophysiol Eur Soc Cardiol. 2019;21(2):332-338. doi:10.1093/europace/euy179.
  9. Pelliccia A, Solberg EE, Papadakis M, et al. Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC). Eur Heart J. 2018;40(1):19-33. doi:10.1093/eurheartj/ehy730.
  10. Samol A, Wollmann C, Vahlhaus C, et al. T-wave integral : an electrocardiographic marker discriminating patients with arrhythmogenic right ventricular cardiomyopathy from patients with right ventricular outflow tract tachycardia. 2013:582-589. doi:10.1093/europace/eus311.
  11. Zaidi A, Sheikh N, Jongman JK, et al. Clinical differentiation between physiological remodeling and arrhythmogenic right ventricular cardiomyopathy in athletes with marked electrocardiographic repolarization anomalies. J Am Coll Cardiol. 2015;65(25). doi:10.1016/j.jacc.2015.04.035.

Notes to editor

Author information:

Dr Gati, Sabiha. Lister Hospital, East & North Hertfordshire NHS Trust.
Prof Sharma, Sanjay, St. George’s, University of London