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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 1 3/2/2010 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 2 3/2/2010 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 3 3/2/2010 4 3/2/2010 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 5 3/2/2010 Does sports per se enhance mortality? Are VEBs can detect those at risk ? Are VEBs a part of physiologic adaptation to athletic training? 6 3/2/2010 7 3/2/2010 8 3/2/2010 9 3/2/2010 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 10 3/2/2010 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 11 3/2/2010 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 12 3/2/2010 13 3/2/2010 14 3/2/2010 15 3/2/2010 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 16 3/2/2010 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 17