Download Ventricular Ectopic Beats: How Many is Too Much?

3/2/2010
Ventricular Ectopic
Beats: How Many is Too
Much?
Pr.Dr Hayam Eldamanhouy,
Ain Shams Univeisty
Ventricular Ectopic Beats
Described in;;
-Appr.
Appr.11%of clinically normal
persons as detected by ECG
-40
40--75
75%
% of apparently
pp
y healthyy
persons as detected by 242448hours
48
hours of Holter ECG
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„ even
frequent
q
( >60
>60/h
/h or 1/min))
and complex (multiform,
alternating, or repetitive pattern, or
R on T beats) occur in apparently
h lth subjects
healthy
bj t
„ An estimated prevalence of 1-4%
of general population
„
It is generally accepted that
frequent and/or complex VEBs
detected in apparently healthy
persons (who are thoroughly
examined byy noninvasive
diagnostic methods) are benign
condition with a favorable
prognosis
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„ Frequent
q
and/or complex
p
ventricular ectopy identifies a
subset of patients in cardiovascular
disease population at increased risk
off death
d th andd sudden
dd cardiac
di death
d th
VEBs in Athletes
„ 24
hour Holter studies showed a
hi h r pr
higher
prevalence
l
off VEB
VEBs iin athletes
thl t
(70%)
70%)
„ 25
25--63%
63% prevalence of complex forms
„ Top
Top--level, highly trained athletes show
morphologic cardiac changes
Palatini, et al,1985
al,1985
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„
„
„
In 490 BC,Phidippids, a young Greek messenger
,ran 26
26..2 miles
il from
f
Marathon
M h to A
Athens
h
Then he collapsed and died
This is probably the first recorded incidence of
SD of an athlete
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„
„
„
Does sports per se enhance mortality?
Are VEBs can detect those at risk ?
Are VEBs a part of physiologic adaptation to
athletic training?
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Can p
physiologic
y
g cardiac remodellingg
induced by training facilitate the
occurrence of SCD in a normal
heart?
Some investigators suspect that it is not
always
l
possible
ibl to di
distinguish
i i h marked
k d
myocardial changes induced by physical
training from those associated with an early
stage of cardiomyopathy
„ Such considerations appear of particular
relevance in the presence of frequent and
complex VA
„
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Ector J et al ( Eur Hert J 2007)
2007) suspected
that endurance sports by itself may lead to
right ventricular enlargement with possible
electrical changes that might not have
developed without the activity
„ Long
Long--lasting volume overload has been
suggested as the responsible mechanism
„
„
Sharhag et al (JACC 2002
2002)) concluded that
extensive endurance training results in
symmetrical changes in left and right
ventricular dimensions confirming the
concept that the athlete's heart is a
b l
balanced
d enlarged
l
d and
d normally
ll
functioning heart
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A recent work (Biffi A et al. AmJCardiol
2008)) showed that LV remodeling is not
2008
related to the presence and frequency of
VA in elite athletes free of cardiovascular
abnormalities
„ Paradoxically, trained athletes with the
smallest extent of LV remodeling
demonstrated a tendency to more frequent
VA
„
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ARVCM
The finding at preparticipation screening of
even isolated premature ventricular
contractions with LBBB morphology
associated with T wave inversion in right
precordial leads with or without family
hi
history
off premature SCD or personall
history of palpitations or syncope should
raise the suspicion of ARVC and leads to
further diagnostic tests
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Sports and Risk of Death
„ Sports
p
p
per se, are not a cause of
enhanced mortality , but they can
trigger sudden death in athletes
with heart or blood vessel disease
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