Landry Cameron H, Fatah Meena, Connelly Kim A, Angaran Paul, Hamilton Robert M, Dorian Paul
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Paediatrics (Cardiology) and the Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada.
CJC Open. 2020 Dec 18;3(4):498-503. doi: 10.1016/j.cjco.2020.12.011. eCollection 2021 Apr.
Arrhythmogenic right-ventricular cardiomyopathy (ARVC) is an identified cause of sport-related sudden cardiac arrest (SCA). Identifying athletes with ARVC and restricting them from exercise is believed to reduce the risk of SCA. The electrocardiogram (ECG) is considered to be an important component of screening for ARVC; however, the sensitivity of the 12-lead ECG to identify ARVC in young asymptomatic persons is unknown.
In this retrospective study, we identified 70 patients (49 ARVC-positive, based on Task Force Criteria, and 21 age-matched ARVC-negative persons from a paediatric arrhythmia database (<18 years of age); ECGs were analyzed for abnormalities, based on International Criteria for Interpretation of ECGs in Athletes, and ECG findings were adjudicated by group consensus.
Of the 49 ARVC-positive patients (median age: 17 [interquartile range: 16-18], 65% male), 22% were found to have abnormal ECGs; the most common ECG findings were T-wave inversions. Patients with symptoms were more likely to have abnormal ECGs than asymptomatic patients (28% compared with 17%, respectively; = 0.002). Of 16 gene-positive patients, 31% had abnormal ECGs. Patients with abnormal ECGs had larger right-ventricular end-diastolic volume indexes on magnetic resonance imaging than those with normal ECGs ( = 0.03).
The ECG was insensitive for detecting ARVC in young (age <18 years), asymptomatic patients, and is unlikely to provide significant diagnostic value for identifying ARVC on routine preparticipation screening of adolescent athletes.
致心律失常性右室心肌病（ARVC）是运动相关心脏性猝死（SCA）的一个已明确病因。识别患有ARVC的运动员并限制其运动被认为可降低SCA风险。心电图（ECG）被视为ARVC筛查的重要组成部分；然而，12导联心电图在识别年轻无症状人群中ARVC的敏感性尚不清楚。
在这项回顾性研究中，我们从一个儿科心律失常数据库（年龄<18岁）中确定了70例患者（49例根据工作组标准为ARVC阳性，21例年龄匹配的ARVC阴性者）；根据运动员心电图解读国际标准分析心电图异常情况，并通过小组共识对心电图结果进行判定。
在49例ARVC阳性患者中（中位年龄：17岁[四分位间距：16 - 18岁]，65%为男性），22%被发现心电图异常；最常见的心电图表现为T波倒置。有症状的患者比无症状患者更有可能出现心电图异常（分别为28%和17%；P = 0.002）。在16例基因阳性患者中，31%有心电图异常。心电图异常的患者在磁共振成像上的右室舒张末期容积指数大于心电图正常的患者（P = 0.03）。
心电图在检测年轻（年龄<18岁）无症状患者的ARVC方面不敏感，在青少年运动员常规参赛前筛查中识别ARVC不太可能提供显著的诊断价值。
