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Nonischemic Left Ventricular Scar as a Substrate of LifeThreatening Ventricular Arrhythmias and Sudden Cardiac Death in Competitive Athletes by Alessandro Zorzi, Martina Perazzolo Marra, Ilaria Rigato, Manuel De Lazzari, Angela Susana, Alice Niero, Kalliopi Pilichou, Federico Migliore, Stefania Rizzo, Benedetta Giorgi, Giorgio De Conti, Patrizio Sarto, Luis Serratosa, Giampiero Patrizi, Elia De Maria, Antonio Pelliccia, Cristina Basso, Maurizio Schiavon, Barbara Bauce, Sabino Iliceto, Gaetano Thiene, and Domenico Corrado Circ Arrhythm Electrophysiol Volume 9(7):e004229 July 7, 2016 Copyright © American Heart Association, Inc. All rights reserved. A 42-y-old martial art player presenting with frequent and coupled premature ventricular beats with right bundle branch block/superior axis morphology during exercise testing (A). Alessandro Zorzi et al. Circ Arrhythm Electrophysiol. 2016;9:e004229 Copyright © American Heart Association, Inc. All rights reserved. A 23-y-old soccer player who suffered syncope during a match. Alessandro Zorzi et al. Circ Arrhythm Electrophysiol. 2016;9:e004229 Copyright © American Heart Association, Inc. All rights reserved. Short-axis postcontrast cardiac magnetic resonance views of a 27-y-old rower with frequent premature ventricular beats with a left bundle branch block/inferior axis morphology (suggestive of right ventricular outflow tract origin) (A) and in a 31-y-old healthy marathon runner without arrhythmias (B) showing late gadolinium enhancement with a spotty pattern at the inferior insertion point of the right ventricular free wall to the interventricular septum (black arrows). Alessandro Zorzi et al. Circ Arrhythm Electrophysiol. 2016;9:e004229 Copyright © American Heart Association, Inc. All rights reserved. A 18-y-old tennis player who underwent contrast-enhancement cardiac magnetic resonance for inferolateral T-wave inversion at baseline 12-lead ECG (A) and frequent ventricular ectopic beats with a right bundle branch block/superior axis at exercise testing (B). Alessandro Zorzi et al. Circ Arrhythm Electrophysiol. 2016;9:e004229 Copyright © American Heart Association, Inc. All rights reserved. Long-axis (A and C) and short-axis (B and D) postcontrast cardiac magnetic resonance views of two 34-y-old identical twin brothers showing a subepicardial/midmyocardial stria of late gadolinium enhancement involving the lateral and inferolateral left ventricular wall (white arrows). Alessandro Zorzi et al. Circ Arrhythm Electrophysiol. 2016;9:e004229 Copyright © American Heart Association, Inc. All rights reserved. A, Kaplan–Meier analysis for survival from major arrhythmic events (sudden death, cardiac arrest because of ventricular fibrillation, sustained ventricular tachycardia, or appropriate implantable cardiac defibrillator shock) in athletes with ventricular arrhythmias and late gadolinium enhancement (LGE), in athletes with ventricular arrhythmias and no LGE, and in controls (with or without spotty LGE). Alessandro Zorzi et al. Circ Arrhythm Electrophysiol. 2016;9:e004229 Copyright © American Heart Association, Inc. All rights reserved.