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Figure 1

Atrial fibrillation was conducted over a Kent bundle with a short anterograde refractory period associated with a minimal pre-excited RR interval of ~200 ms. At the end of the ECG recording, AF degenerates into ventricular fibrillation.Note. RR: two R-waves, ECG: electrocardiogram, AF: atrial fibrillation
Atrial fibrillation was conducted over a Kent bundle with a short anterograde refractory period associated with a minimal pre-excited RR interval of ~200 ms. At the end of the ECG recording, AF degenerates into ventricular fibrillation.Note. RR: two R-waves, ECG: electrocardiogram, AF: atrial fibrillation

Inclusion and exclusion criteria

Inclusion criteria
1. ECG showing a WPW pattern (mandatory)
2. ECG documented arrhythmia +/− structural heart disease
3. Aborted SD or syncope
4. Typical symptoms (sudden onset and termination of palpitations) alone or associated with sudden familial death with or without ECG-tracing documentation

Dimensions of the left heart structures in athletes with WPW syndrome/pattern

Echographic Findings in Athletes with WPW, Mean Values
LV end-diastolic diameter 4.53 ± 0.60 cm
LV end-systolic diameter 2.70 ± 0.57 cm
IVS 1.00 ± 0.15 cm
PWLV 0.96 ± 0.16 cm
EFLV 65.39 ± 6.96%
LA surface 17.42 ± 2.71 cm2

Distribution of accessory pathways according to localization

Localization of the APs n (%)
Left-sided 39 (46.42)
Right-sided 36 (42.84)
Midseptal & anteroseptal 9 (10.71)
Multiple pathways (4LS, 3 LR, 2 RS) 9 (10.71)

Distribution of patients with sudden death risk criteria

Parameters WPW syndrome n (%) WPW pattern n (%) Total n (%)
Short EARP AP<250 ms 15 (17.85) 2 (2.38) 17 (20.23)
Minimal pre-excited RR interval during AF <250 ms 1 (1.19) 2 (2.38) 3 (3.57)
Reentry tachycardia with hemodynamic collapse and syncope 0 (0) 1 (1.19) 1 (1.19)
Syncope during pre-excited AF 2 (2.38) 1 (1.19) 3 (3.57)

Distribution of patients by age-standardized groups

Category Age n (%)
Children 10–11 8 (9.52)
Cadets 12–13 7 (8.33)
Junior 14–16 6 (7.14)
Youth 17–18 9 (10.71)
Seniors >18 54 (64.28)

The distribution of athletes by endurance/nonendurance sports

Sports, n (%) Total
Cycling 12 (14.28)
Endurance Sports Cross country/marathon running 18 (21.40) 38 (45.23%)
Swimming 6 (7.14)
Rugby 2 (2.38)
Football 25 (29.76)
Judo 5 (5.95)
Handball 5 (5.95)
Nonendurance Sports Basketball 4 (4.76)
Kayaking 3 (3.57)
Gymnastics 2 (2.38) 46 (54.76)
Outdoor climbing 1 (1.19)
Ice skating 1 (1.19)
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