Copyright © 1988 by the European Society of Cardiology.
© 1988 The European Society of Cardiology
Induction of supraventricular tachyarrhythmia at rest and during exercise with transoesophageal atrial pacing in the electrophysiological evaluation of asymptomatic athletes with Wolff-Parkinson-White Syndrome
Division of Cardiology and Arrhythmologic Centre, S. Chiara Hospital Trento, Italy
Received 29 September 1987; revised 25 January 1988; .
Address for correspondence: Dott. Giuseppe Vergara. Divisione di Cardiologia e, Centro Aritmologico, Ospedale S. Chiara. 38100 Trento, Italy.
Abstract
Even today there is controversy as regards the best approach to asymptomatic or slightly symptomatic athletes with the WPM syndrome as regards fitness for sports activity, especially in some countries where the doctor is responsible for certifying sports fitness. This study concerns 84 asymptomatic or slightly symptomatic athletes (66 males, 18 females, mean age 21.7 years, range 12–44 years) who underwent a stimulation protocol the end-point of which was the induction of atrial fibrillation (or, if not possible, atrial tachyarrhythmia) in the basal state and during bicycle stress test with transesophageal atrial pacing. The 81 athletes in whom the end-point was reached were divided into two groups: Group I includes the 32 athletes with the shortest R–R interval between pre-excited beats 
240 ms in the basal state and /or 210 ms during bicycle ergometer test, Group II includes the other 49 patients. The evaluation during exercise was not carried out in four athletes because of serious haemodynamic compromise due to the arrhythmia induced in the basal state. Only 21/32 athletes would have been included in Group I if only evaluated in the basal state.
In 30/81 athletes (37%), there was discrepancy between the result of stimulation and the result of the usual non-invasive evaluation (Holter monitoring, ergometric stress test, ajmaline test). On average, 40 min are required for the performance of the study protocol except when the induced arrhythmia lasts more than 5 min.
The follow-up of the Group I athletes ranged from 10 to 36 months (mean 20.5 months); three athletes became symptomatic and in two of these the clinical arrhythmia was like the one induced.
On the basis of our results, we conclude that the induction of atrial fibrillation under stress is useful in screening athletes with WPM syndrome; and, as it is simple to perform and economical (in time, equipment and staff), we regard this protocol as fundamental for the electrophysiological evaluation of athletes with Wolff–Parkinson–White syndrome.
Key Words: Wolff–Parkinson–White syndrome • electrophysiology • sports cardiology