La sindrome da preeccitazione ventricolare

Translated title of the contribution: [Autom. eng. transl.] Ventricular pre-excitation syndrome

Riccardo Fenici, Donatella Brisinda, Angela Venuti

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

[Autom. eng. transl.] The electrophysiological study protocol of the athlete with WPW Syndrome must be set up in the most dynamic and individualized way possible, taking into due consideration the effects of sympatho-vagal modulation related to specific athletic conditioning and the fact that, depending on the personality profile , the psychophysiological stress induced by a particular type of competition and by the degree and level of agonistic commitment can determine significant variations of apparently "reassuring" electrophysiological parameters in basal conditions, with unexpected proarrhythmic effects for the purposes of a correct stratification of the arrhythmic risk in patients with PEV. The transesophageal electrophysiological study (SETE) is an adequate method for the quantification of electrophysiological parameters, risk markers and for the follow-up of patients with WPW syndrome, provided that the parameters are evaluated in dynamic conditions, as the acute electrophysiological remodeling of conduction / Anterograde refractoriness of the NAV and the accessory pathway can also vary significantly depending on fluctuations in the autonomotropic balance. An incomplete and / or non-contextualized determination can cause an incorrect prognostic evaluation. The inducibility of orthodromic TRAV and the detection of short SPERRI are prevalent in symptomatic subjects compared to asymptomatic subjects. The predictive value of SPERRI as the only parameter of classification of the arrhythmic risk in athletes with asymptomatic PEV is questionable. In fact, the specificity of SPERRI is progressively reduced by raising the threshold level above 220 msec in rest conditions. It is therefore likely that, in the absence of symptoms and / or inducibility of FA, the SPERRI value foreseen by the current guidelines (<250 msec) as a threshold to prescribe an ablation is excessively non-specific. However, having to consider the problem from a medical-sports (and medico-legal) point of view, it is reasonable to use the threshold values provided by the current COCIS protocol, simplifying its current formulation with SPERRI thresholds in FA not lower than 240 msec at rest, and at 200 msec, under stress. It has also emerged from recent studies that, in adult patients, where the parameters are reproducibly not at risk in at least seven electrophysiological follow-up studies, no deterioration is observed even prolonging the observation for over fifteen years; in addition, around 20% of cases can improve. On the other hand, although rarely (less than 5% of cases), the electrophysiological characteristics of some accessory pathways may undergo unfavorable variations, especially in the evolutionary and growth phases. Therefore, if you prefer to follow a conservative approach, it is appropriate to monitor the patient with periodic SETE, as required for the certification of suitability for competitive sport.
Translated title of the contribution[Autom. eng. transl.] Ventricular pre-excitation syndrome
Original languageItalian
Title of host publicationCardiologia dello sport
EditorsPAOLO ZEPPILLI
Pages459-496
Number of pages38
Publication statusPublished - 2014

Keywords

  • Aritmie cardiache
  • Morte improvvisa
  • Rischio aritmico
  • Sindrome di Wolff-Parkinson-White
  • Studio elettrofisiologico transesofageo

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