The Significance of Early Repolarization and Incomplete Right Bundle Block in Athletes

Abstract

Sudden death in athletes is a major concern. The predictors and value of prior investigations remain to be settled. Of the electrocardiographic findings (ECG) is early repolarization, its incidence and significance is the subject of this work. Methods: The study included hundred persons engaged in competitive sports for duration not less than 6 months; with training at least 3 days per week and at least 2 h per day. All were males. Collection of cases started March till December. 2015. Full history especially for syncope, palpitations or chest pain was obtained as well as family history of sudden death or coronary disease. Examination for BP, any cardiac murmur or arrhythmia. ECG was done for all plus echo Doppler for some cases. Early repolarization was accepted present if J point is elevated more than one mm in LII, LIII, aVF or ST elevation more than 1 mm in chest leads. RV conduction disturbance was considered present if there is Rsr' or bifid R in V1 or V2. Minor or minimal changes were not counted. During the period from 1/1/2015 to 1/10/2016, 100 athletes were screened by ECG, mean age 23 years; 54 played isotonic (dynamic) sports (Bicycling 6, Football 15, Tennis 3, Basketball 16, Volleyball 8, Swimming 4, Boxing 2). Forty-six isometric (static) sports body builders. Follow up by telephone quesionnaire was done. Results: Twenty-three had either or both abnormalities. Early repolarization (Fig.) was found in 19, and Rsr' was present in 9 (5 had both). None was diagnosed as Brugada or RV dysplasia. Exercise ECG was not done, provocation tests were not done. Follow up was up to 2 years. No one reported tachyarrhythmia or syncope neither before recruitment in the study (retrospective) nor after follow up (prospective). Conclusion: Early repolarization and RV conduction disturbance did not prove hazardous.