L.A. BALYKOVA¹, L.M. MAKAROV², I.A. GORBUNOVA¹, V.N. KOMOLYATOVA², A.A. SHIROKOVA¹, A.M. TISHINA¹

¹Ogarev Medical Institute of Mordovia State University, 68 Bolshevistskaya St., Saransk, Russian Federation 430005

²Center of Syncope States and Cardiac Arrhythmias of FMBA of Russia, 20 Moskvorechye, Moscow, Russian Federation 115409

Balykova L.A. — D. Med. Sc., Professor, Director of the Medical Institute of the Ogarev Mordovia State University, Head of Pediatric Department, tel.: (8342) 35-30-02, 32-19-83, e-mail: larisabalykova@yandex.ru¹

Makarov L.M. — D. Med. Sc., Professor, Head of Syncope States and Cardiac Arrhythmias Center of FMBA of Russia, tel. (495) 324-75-09, e-mail: csssa@mail.ru²

Gorbunova I.A. — Cand. Med. Sc., doctor of Functional Diagnostics Department of Mordovia Republic Children’s Hospital¹

Komolyatova V.N. — Cand. Med. Sc., employee of Syncope States and Cardiac Arrhythmias Center of FMBA of Russia, tel. (495) 324-75-09, e-mail: verakom@list.ru²

Shirokova A.A. — postgraduate student of Pediatric Department of Children’s Medical Center, tel. +7-973-517-87-37, e-mail: asamo6@yandex.ru¹

Tishina A.M. — resident doctor of Pediatric Department, tel. (8342) 35-30-02, e-mail: ponita111@yandex.ru¹

100 athletes and 100 healthy untrained children of 11-15 yrs were examined by veloergometry, Bruce protocol. The athletes vs untrained children have shown higher values of RR and QT at rest, a smoother increase in the heart rate (HR) and QT at the initial stage of exercise, as well as a prompt return to the original value at the 3^rd – 4^th minute of recovery period. In athletes, the maximal QTc values were registered at the initial stage of exercise, minimal — at the peak of exercise. The absence of the appropriate QTc shortening at the peak of exercise and/or excessive prolongation at the 3^rd – 4^th minute of recovery period is suggestive of the adaptation breakdown, which can give evidence of cardiac disorders in athletes.

Key words: children-athletes, exercise, myocardial repolarization processes.

 

 

 

REFERENCES

1. Siddiqui S., Patel D.R. Cardiovascular screening of adolescent athletes. Pediatr Clin North Am., 2010, June, vol. 57 (3), pp. 635-647.

2. Zipes D.P., Camm A.J., Borggrefe M., Buxton A.E., Chaitman B., Fromer M., Gregoratos G., Klein G., Moss A.J., Myerburg R.J., Priori S.G., Quinones M.A., Roden D.M., Silka M.J., Tracy C., Smith S.C. J.r, Jacobs A.K., Adams C.D., Antman E.M., Anderson J.L., Hunt S.A., Halperin J.L., Nishimura R., Ornato J.P., Page R.L., Riegel B., Priori S.G., Blanc J.J., Budaj A., Camm A.J., Dean V., Deckers J.W., Despres C., Dickstein K., Lekakis J., McGregor K., Metra M., Morais J., Osterspey A., Tamargo J.L., Zamorano J.L.. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology. American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace, 2006, vol. 8, pp. 746-837.

3. Schmied C., Borjesson M. Sudden cardiac death in athletes. J Intern Med., 2014, Feb., vol. 275 (2), pp. 93-103.

4. Maron B.J., Doerer J.J., Haas T.S., Tierney D.M., Mueller F.O. Sudden death in young competitive athletes. Analysis of 1866 Deaths in the United States, 1980-2006. Circulation, 2009, vol. 119, pp. 1085-1092.

5. Maron B.J., Thompson P.D., Ackerman M.J., Balady G., Berger S., Cohen D., Dimeff R., Douglas P.S., Glover D.W., Hutter A.M. J.r, Krauss M.D., Maron M.S., Mitten M.J., Roberts W.O., Puffer J.C. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: A scientific statement from the American heart association council on nutrition, physical activity, and metabolism: endorsed by the American College of Cardiology Foundation. Circulation, 2007, vol. 115, pp. 1643-1655.

6. Corrado D., Pelliccia A., Bjørnstad H., Vanhees L., Biffi A., Borjesson M., Panhuyzen-Goedkoop N., Deligiannis A., Solberg E., Dugmore D., Mellwig K.P., Assanelli D., Delise P., van-Buuren F., Anastasakis A., Heidbuchel H., Hoffmann E., Fagard R., Priori S.G., Basso C., Arbustini E., Blomstrom-Lundqvist C., McKenna W.J., Thiene G.. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur. Heart, 2005, vol. 26, pp. 516-524.

7. Sofi F., Capalbo A., Pucci N., Giuliattini J., Condino F., Alessandri F., Abbate R., Gensini G.F., Califano S. Cardiovascular evaluation, including resting and exercise electrocardiography, before participation in competitive sports: cross sectional study. BMJ, 2008, Jul 3, pp. 337-346.

8. Gibbons R.J., Balady G.J., Bricker J.T., Chaitman B.R., Fletcher G.F., Froelicher V.F., Mark D.B., McCallister B.D., Mooss A.N., O’Reilly M.G., Winters W.L. J.r, Gibbons R.J., Antman E.M., Alpert J.S., Faxon D.P., Fuster V., Gregoratos G., Hiratzka L.F., Jacobs A.K., Russell R.O., Smith S.C. Jr. American College of Cardiology.American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology. American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation, 2002, Oct 1, vol. 106 (14), pp. 1883-1892.

9. Locati E., Pancaldi A., Pala M., Schwartz P.J.. Exercise-induced electrocardiographic changes in patients with the long QT syndrome. Circulation, 1988, vol.78 (Suppl II), p. 42.

10. Vincent G.M., Jaiswal D., Timothy K.W. Effects of exercise on heart rate, QT, QTc and QT/QS2 in the Romano-Ward inherited long QT syndrome. Am J Cardiol., 1991, vol. 68, p. 498-503.

11. Schwartz P.J., Priori S.G., Locati E.H., Napolitano C., Cantu` F., Towbin J.A., Keating M.T., Hammoude H., Brown A.M., Chen L.S. Long QT syndrome patients with mutations of the SCN5A and HERG genes have differential responses to Na-channel blockade and to increases in heart rate: implicationsfor gene-specific therapy. Circulation, 1995, vol. 92, p. 3381-3386.

12. Takenaka K., Ai T., Shimizu W., Kobori A., Ninomiya T., Otani H., Kubota T., Takaki H., Kamakura S., Horie M. Exercise stress test amplifies genotype-phenotype correlation in the LQT1 and LQT2 forms of the long-QT syndrome. Circulation, 2003, vol. 107, pp. 838-844.

13. Wong J.A., Gula L.J., Klein G.J., Yee R., Skanes A.C., Krahn A.D. Utility of Treadmill Testing in Identification and Genotype Prediction in Long-QT Syndrome. Circ Arrhythm Electrophysiol., 2010, vol. 3, pp. 120-125.

14. Schwartz P.J., Crotti L.. QTc Behavior During Exercise and Genetic Testing for the Long-QT Syndrome. Circulation, 2011, vol. 124, pp. 2181-2184.

15. Corrado D., Pelliccia A., Heidbuchel H. Sharma S., Link M., Basso C., Biffi A., Buja G., Delise P., Gussac I., Anastasakis A., Borjesson M., Bjørnstad H.H., Carrè F., Deligiannis A., Dugmore D., Fagard R., Hoogsteen J., Mellwig K.P., Panhuyzen-Goedkoop N., Solberg E., Vanhees L., Drezner J., Estes N.A. 3rd, Iliceto S., Maron B.J., Peidro R., Schwartz P.J., Stein R., Thiene G., Zeppilli P., McKenna W.J. Section of Sports Cardiology, European Association of Cardiovascular Prevention and Rehabilitation. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J., 2010, Jan., vol. 31 (2), pp. 243-259.

16. Uberoi A., Stein R., Perez M.V., Freeman J., Wheeler M Dewey F., Peidro R., Hadley D., Drezner J., Sharma S., Pelliccia A., Corrado D., NiebauerJ., Estes IIINA M., Ashley E., Froelicher V . Interpretation of the Electrocardiogram of Young Athletes. Circulation, 2011, Aug 9., vol. 124 (6), pp. 746-757.

17. Basavarajaiah S., Wilson M., Whyte G., et al. Prevalence and significance of an isolated long QT interval in elite athletes. Eur Heart Journal, 2007, 28, pp. 2944-2949.

18. Napolitano C., Bloise R., Priori S.G. Long QT syndrome and short QT syndrome: how to make correct diagnosis and what about eligibility for sports activity. J Cardiov Med., 2006, vol. 7, pp. 250-256.

19. Kapetanopoulos A., Kluger J., Maron B.J., Thompson P.D. The congenital long QT syndrome and implications for young athletes. Med Sci Sports Exerc., 2006, vol. 38, pp. 816-825.

20. Bazett H.Analysis of the time relations of electrocardiograms. Heart, 1920, vol. 7, pp. 353-370.

21. Fridericia L. Die systolendauer im Elektrokardiogramm bei normalen Menschen und bei Herzkranken. Act Med. Scand., 1920, vol. 53, pp. 469-472.

22. Buchheit M., Gindre C. Cardiac parasympathetic regulation: respective associations with cardiorespiratory fitness and training load. Am. J. Physiol., 2006, vol. 291, pp. 451-458.

23. Komolyatova V.N., Makarov L.M., Kolosov V.O., Kiseleva I.I., Fedina N.N. Electrocardiographic features in young elite athletes. Pediatriya, 2013, vol. 3, pp. 66-72 (in Russ.).

24. Makarov L.M., Komolyatova V.N, Fedina N.N, Balykova L.A, Gorbunova I.A Dynamics of the QT interval at veloergometry in young girls athletes and persons who are not involved in sports. Materialy III Vserossiyskogo kongressa s mezhdunarodnym uchastiem “Meditsina dlya sporta — 2013”. Sportivnaya meditsina: nauka i praktika. Appl. 1 (10), 2013, p. 165 (in Russ.).

25. Makarov L.M., Balykova L.A., Komolyatova V.N., Gorbunova I.A. Changes in the QT interval during the test with exercise stress in healthy adolescents 11-15 years. Kardiologiya, 2012, no. 9, pp. 15-21 (in Russ.).

26. Meerson F.Z., Pshennikova M.G. Adaptatsiya k stressovym situatsiyam i fizicheskim nagruzkam [Adaptation to stress and physical stress]. Moscow: Meditsina,1988. No. 25. P. 6.

27. Viru A.A., Kyrge A.A. Gormony i sportivnaya rabotosposobnost’ [Hormones and athletic performance]. Moscow: FiS, 1983. P. 159.

28. Magnano A.R., Holleran S., Ramakrishnan R,. Reiffel J.A., Bloomfield D.M. Autonomic nervous system influences on QT interval in normal subjects. Jam Coll Cardiol., 2002, vol. 39, pp. 1820-1826.

29. Sy R.W., van der Werf C., Chatta I.S., Chockalingam P., Adler A., Healey J.S., Perrin M., Gollob M.H., Skanes A.C., Yee R., Gula L..J, Leong–Sit P., Viskin S., Klein G.J., Wilde A.A., Krahn A.D. Derivation and validation of a simple exercise-based algorithm for prediction of genetic testing in relatives of LQTS probands. Circulation, 2011, vol. 124, pp. 2187-2194.

30. Gorbunova I.A. Vliyanie dozirovannoy fizicheskoy nagruzki na protsessy adaptatsii i dizadaptatsii serdechno-sosudistoy sistemy u detey i podrostkov v norme i pri patologii: avtoref. dis. … kand. med. nauk [Graduated exercise influence on the processes of adaptation and disadaptative cardiovascular system in children and adolescents in health and disease. Synopsis of the dis. Of PhD Med. Sci.]. Saransk, 2009. P. 21.

31. Aziz P.F., Wieand T.S., Ganley J., Henderson J., Patel A.R., Ramesh Iyer V., Vogel R.L., McBride M., Vetter V.L., Shah M.J. Genotype and Mutation Site Specific QT Adaptation during Exercise, Recovery and Postural Changes in Children with LQTS. Circ Arrhythm Electrophysiol., 2011, Dec 1, vol. 4 (6), pp. 867-873.

32. Iacoviello M., Forleo C., Guida P., Romito R., Sorgente A., Sorrentino S., Catucci S., Mastropasqua F., Pitzalis M. Ventricular repolarization dynamicity provides independent prognostic information toward major arrhythmic events in patients with idiopathic dilated cardiomyopathy. J Am Coll Cardiol., 2007, July 17, vol. 50 (3), pp. 232-233.