The Risk of Sudden Death Associated with Symptomatic and Asymptomatic Ventricular Pre-excitation in Athletes

Figure 1

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)