Background

Since the early 80s’, competitive Italian athletes must undergo annual pre-participation screening to detect cardiovascular conditions at risk of sudden cardiac death. Strange and rare ECG pictures may be observed. Premature beats, whether isolated or repetitive, are the most common arrhythmic events and can be very easy to diagnose, but sometimes difficult to interpret. Atrial and ventricular extrasystoles account for most of them, while arrhythmias originating from the specialized conduction system other than the left bundle fascicles are rare and mostly unrecognized.

The case

In young competitive athletes, ventricular arrhythmias could be a reason for concern as they may represent the sign of a serious underlying cardiac condition. On the other hand, atrial or conduction system premature beats are usually benign. However, when the properties of the His-Purkinje system lead to conduction aberrancies, there is a risk of misinterpreting benign arrhythmias (such as premature atrial beats) as potentially at-risk ventricular ectopic beats.

An asymptomatic 15 year-old soccer player with unremarkable past medical and familial history had undergone the annual pre-participation screening. Resting ECG revealed brief paroxysms of asymptomatic tachycardia featured by the alternation of narrow and wide QRS complexes with both right-bundle-branch (RBBB) and left-bundle-branch-block (LBBB) morphologies. He was then referred to the Cardiology Unit for further evaluation. 

Test your knowledge

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 on the site are only examples and do not guarantee outcomes from formal examinations.

Case report

Read the corresponding case report:

Interpolated junctional extrasystoles mimicking complex polymorphic ventricular arrhythmias in a healthy young athlete

Nicolò Martini, Bortolo Martini, Domenico Corrado, Alessandro Zorzi

European Heart Journal - Case Reports, Volume 8, Issue 2, February 2024, ytae012, https://doi.org/10.1093/ehjcr/ytae012