Ablazione.org – Terapia delle aritmie

A cura del Dr. Igino Contrafatto M.D. – Cardiac Electrophysiology – Salus Hospital – Reggio Emilia

WPW and Sports participation

Preparticipation assessment of athletes at various levels, including high school, can include an ECG and thus a diagnosis of WPW is sometimes made in this context.
WPW syndrome accounted for approximately 1% of deaths in a long-term registry of sudden death in athletes. However, it is not known whether these were asymptomatic individuals by definition. Many of the cases of SCD with WPW have an association with exercise.
Based on the 36th Bethesda Conference, risk stratification with an EP study is advisable in asymptomatic athletes engaged in moderate- to high-level competitive sports; a slightly more aggressive statement from the European Society of Cardiology, which mandates that all athletes with WPW undergo comprehensive risk assessment including an EP study. Assessment of the risk profile in these athletes include the (Shortest Preexcited R-R Interval) SPERRI <240 ms in AF or <220 ms during stress or isoproterenol, presence of multiple accessory pathways, or easily inducible AF. While ablation has generally been recommended in asymptomatic athletes with WPW, for those individuals refusing ablation or those with a parahisian location, competitive sports may be allowed if none of the aforementioned EP risk factors are present. While there are currently differences between the European and American Cardiology Societies recommendations in the management of asymptomatic athletes with a WPW ECG pattern, the discovery of ventricular preexcitation in an adolescent, regardless of athletic status, should prompt referral to a specialist with expertise in pediatric electrophysiology to initiate the process of risk stratification, as detailed in this chart.

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