INFLUENCE OF COVID 19 ON MORPHOLOGICAL AND CARDIOVASCULAR STATUS OF PROFESSIONAL HANDBALL PLAYERS

Handball is one of the very popular sports games in the world. The current COVID 19 pandemic directly affects handball players in the training and competition processes from all age categories but professional players seem to be at a higher risk of contracting the disease. This study aimed to assess morphological and cardiovascular status of 20 participants, professional handball players who compete at elite competition rank, and therewith to adjust their training process and to test the differences between COVID 19 positive and COVID 19 negative participants. Testing included measurements of basic morphological parameters while the function of the cardiovascular system (CVS) was assessed at rest and effort - exercise stress test with Vita Maxima protocol. The results of t-test did not show a statistically significant difference in morphological and cardiovascular characteristics of participants who had COVID 19 infection (with a positive PCR test), who had symptoms of infection but no PCR test for the virus, and those who did not contract COVID 19.

Premature Ventricular Contractions During the Recovery Phase of Exercise Are Only Associated with Increased Cardiovascular Mortality when Present Together with Echocardiographic Abnormalities

Background: Premature ventricular contractions (PVCs) during the recovery of exercise stress testing are associated with increased cardiovascular mortality, but the cause remains unknown. We aimed to evaluate the association of PVCs during recovery with abnormalities on echocardiography, and to evaluate their combined prognostic performance. Methods: Echocardiographic abnormalities (reduced left ventricular (LV) ejection fraction, valvular heart disease, LV dilatation, LV hypertrophy, or increased filling pressures) and the presence of PVCs during recovery (≥1/min) were identified among patients having undergone resting echocardiography within median [interquartile range] 0 [0-2] days of an exercise stress test. The association between such changes and cardiovascular mortality was analyzed using Cox regression adjusted for age, sex, clinical and exercise variables. Results: Among included patients (n=3,106, 219 events, 7.9 [5.4-11.1] years follow-up), PVCs during recovery was found in 1,327 (43%) patients, among which prevalence of echocardiographic abnormalities was increased (58% vs. 43%, p<0.001). Overall, PVCs during recovery was associated with increased cardiovascular mortality (adjusted hazard ratio (HR) [95% confidence interval] 1.6 [1.2-2.1], p<0.001). When combined with echocardiographic abnormalities, PVCs during recovery was only associated with increased risk when such were present (adjusted HR 3.3 [2.0-5.4], p<0.001), and not when absent (adjusted HR 1.4 [0.7-2.6], p=0.26), in reference to those with neither. Conclusion: PVCs during recovery was associated with increased prevalence of echocardiographic abnormalities. Increased risk of cardiovascular mortality was observed only for subjects with PVCs if concomitant echocardiographic abnormalities were present. This provides a structural explanation for the increased long-term cardiovascular risk among patients with PVCs during recovery.

641 Left ventricular non-compaction as a distinct cardiomyopathy or a phenotypic feature: a case report

A 71-year-old male with no cardiovascular risk factors and a history of two uninvestigated episodes of loss of consciousness one year before, presented in our department to undergo a treadmill exercise stress test in relation to inverted T waves in V5-V6 on his basal ECG and frequent ventricular extrasystoles (PVCs). The stress test was positive for inducible ischemia, with a significant depression of the ST-segment in the lateral lead. A transthoracic echocardiography revealed normal thicknesses and volumes of the left ventricle (LV) with a dyskinesia of the lateral wall and a mildly reduced ejection fraction (EF) up to 46%. Epicardial surface was unremarkable. Next, a coronary angiography showed no critical obstruction in the epicardial coronary arteries. In order to further investigate the frequent PVCs and the reduction of the LV systolic function, a cardiac magnetic resonance (CMR) with paramagnetic contrast agent was performed. The images outlined the presence of non-compaction in the distal lateral wall and apex with a late gadolinium enhancement (LGE) in the epicardial portion of the lateral wall (Figure 1). Moreover, the CMR showed an adipose infiltration of the interventricular septum and thickened right ventricular trabeculae, suggesting an overlap with arrhythmogenic left ventricular dysplasia. During the subsequent follow-up, the patient was implanted with an implantable cardiac defibrillator (ICD), after two reported episodes of loss of consciousness and an electrophysiology study (EPS) resulting in the induction of a symptomatic ventricular tachycardia. Non-compaction cardiomyopathy is a rare and still relatively novel nosological entity, which can sometimes be observed in the same patient with other forms of cardiomyopathy. In the context of an unexplained reduction of LVEF and frequent PVCs, the accuracy of CMR in describing cardiac morphology and myocardial layer remains an indispensable tool to detect otherwise underdiagnosed potentially fatal cardiomyopathies.

Dizziness in an avid cyclist: an unusual presentation of a common problem

Background Presyncope and syncope are common presentations with a wide range of differential diagnoses; when it occurs primarily on exertion, a cardiovascular cause is more likely. Structural abnormalities and primary rhythm disturbances are the usual culprits in these patients. Case summary A 75-year-old gentleman presented with a history of progressive exertional presyncope. His investigations demonstrated normal cardiac structure, function, and rhythm. He underwent an exercise stress test, which demonstrated a significant reduction in peak blood pressure with equivocal electrocardiogram changes and absence of ischaemic symptoms. In view of his age and gender, a computerized tomography coronary angiogram (CTCA) was organized to exclude obstructive coronary artery disease (CAD). Intriguingly, the CTCA demonstrated a severe proximal left anterior descending (LAD) artery stenosis. This stenosis was confirmed to be functionally significant using invasive coronary physiology and was treated with percutaneous coronary intervention. At follow-up, there was no recurrence of exertional presyncope and the patient was continuing to return to his baseline function. Conclusion Presyncope and/or syncope as the sole manifestation of obstructive CAD, in the presence of normal ventricular function and valves, has rarely been reported. Myocardial ischaemia-mediated presyncope and/or syncope may be secondary to numerous mechanisms, which are described in this case report. Revascularization of the functionally significant proximal LAD stenosis resulted in cessation of exertional presyncope in our patient. The long-term outcome of revascularization in patients with presyncope and syncope needs to be further investigated.

Ventricular fibrillation arrest due to Brugada syndrome in a COVID-19 patient with negative procainamide challenge: a case report

Background Pharmacologic challenge test is often used to diagnose Brugada syndrome (BrS) when spontaneous ECGs do not show type I Brugada pattern but reported sensitivity varies. The role of exercise stress test in diagnosing Brugada syndrome is not well-established. Case Summary A patient had a type I Brugada pattern ECG during the recovery phase of exercise stress test but had a negative procainamide challenge test. He had a loop recorder implanted and later survived a ventricular fibrillation (VF) arrest provoked by COVID-19. ECG on arrival showed type 1 Brugada pattern. He was discharged after implantable cardioverter-defibrillator (ICD) implantation. He later underwent genetic testing and was found to be heterozygous for c.844C&gt;G (p.Arg282Gly) mutation in the SCN5A gene. Discussion Type 1 Brugada pattern ECG may be unmasked by ST segment augmentation during recovery from exercise. Exercise stress test may play a role in diagnosis of Brugada syndrome when suspicion for Brugada syndrome remains after a negative procainamide challenge test or if the patient has exercise related symptoms. COVID-19 can unmask BrS and trigger a VF cardiac arrest.

Variations in cardiac implantable electronic device surveillance and ancillary testing in the paediatric and congenital heart disease population: an international multi-centre survey from the Paediatric and Congenital Electrophysiology Society

Background: Expert guidance from scientific societies and regulatory agencies recommend a framework of principles for frequency of in-person evaluations and remote monitoring for patients with cardiac implantable electronic devices. However, there are limited data regarding adherence to recommendations among paediatric electrophysiologists, and there are no data regarding cardiac implantable electronic device-related ancillary testing. Methods: To assess current clinical practices for cardiac implantable electronic device in-person evaluation, remote monitoring, and cardiac implantable electronic device-related ancillary testing, the Paediatric and Congenital Electrophysiology Society members were surveyed. The main outcome measures were variations in frequency of in person evaluation, frequency of remote monitoring, and cardiac implantable electronic device-related ancillary testing. Results: All respondents performed in-person evaluation at least once a year, but <50% of respondents performed an in-person evaluation within 2 weeks of cardiac implantable electronic device implantation. Remote monitoring was performed every 3 months for pacemakers and implantable cardioverter defibrillators by 71 and 75% respondents, respectively. Follow-up echocardiography was performed every 2–3 years by 53% respondents for patients with >50% ventricular pacing. Majority of respondents (75%) did not perform either an exercise stress test or ambulatory Holter monitoring or chest X-ray (65%) after cardiac implantable electronic device implantation. Conclusion: This survey identified significant practice variations in cardiac implantable electronic device in- person evaluation, remote monitoring, and ancillary testing practices among paediatric electrophysiologists. Cardiac implantable electronic device management may be optimised by development of a paediatric-specific guidelines for follow-up and ancillary testing.