Document Detail

Wenckebach second-degree A-V block in top-ranking athletes: an old problem revisited.
MedLine Citation:
PMID:  7405798     Owner:  NLM     Status:  MEDLINE    
The occurrence of Wenckebach second-degree (Mobitz I) A-V block in apparently normal persons still provides a puzzle for the cardiologist, as the benign nature of this event has been recently questioned. This problem becomes more intriguing when Wenckebach A-V block is encountered in asymptomatic top-ranking athletes, because of medico-legal implications. We report 10 cases of highly-trained athletes, including three with mitral valve prolapse (MVP) features, with a spontaneous or induced Wenckebach second-degree A-V block. Previous ECGs of six subjects, dating from a maximum of 6 years to a minimum of 18 months, were available. Deterioration of A-V conduction has never been documented and all six cases have remained asymptomatic for the whole follow-up period. Athletes have been submitted to a protocol study consisting of ECG recording at rest, during, and after vagal and sympathetic reflex maneuvers, drug administration (isoproterenol and atropine), submaximal and maximal exercise. Nine subjects have been considered to have "normal" responses of the A-V node to provocative tests, since conduction disturbances were improved or normalized by reflex sympathetic stimulations and were completely normalized by autonomic drug administration and exercise. One athlete showed "abnormal" responses to tests. In order to give a conclusive prognostic and medico-legal assessment, we advised him to submit to an invasive electrophysiological investigation. Wenckebach second-degree A-V block in athletes may be a more common finding than so far described, especially when a systematic search is made. In our opinion, this event can still be considered a vagally-induced benign feature of athlete's heart, provided that an immediate improvement of A-V conduction is obtained in response to reflex sympathetic maneuvers, and that a complete normalization after sympathomimetic and vagolytic drug administration and physical exercise is observed. The clinical histories of our athletes and the observed complete disappearance of conduction disturbances after detraining, strongly support this opinion. Wenckebach second-degree A-V block in asymptomatic athletes with MVP features probably does not affect the prognosis if similar favorable responses to the aforesaid tests are observed.
P Zeppilli; R Fenici; M Sassara; M M Pirrami; G Caselli
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  100     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1980 Sep 
Date Detail:
Created Date:  1980-10-27     Completed Date:  1980-10-27     Revised Date:  2006-02-27    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  281-94     Citation Subset:  AIM; IM    
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MeSH Terms
Atropine / pharmacology
Autonomic Nervous System / physiopathology
Exercise Test
Follow-Up Studies
Heart Block / complications,  diagnosis*
Heart Conduction System / drug effects
Heart Rate
Isoproterenol / pharmacology
Mitral Valve Prolapse / complications
Valsalva Maneuver
Reg. No./Substance:
51-55-8/Atropine; 7683-59-2/Isoproterenol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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