Klinische Sportmedizin

The case of a second look concerning indication for pacemaker implantation due to advanced AV block in a 53-year-old master triathlete is reported. An extrinsic etiology (vagal induction) of the block seemed to be possible in the initial Holter-ECG. Therefore, further diagnostics followed. In repeat...

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Autores principales:	Laszlo R, Radermacher M, Lesevic H, Steinacker JM
Formato:	article
Lenguaje:	DE EN
Publicado:	Dynamic Media Sales Verlag 2017
Materias:	Sports medicine RC1200-1245
Acceso en línea:	https://doaj.org/article/ae6e053dfbe34d3e9cc1d7e603e5e231
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id	oai:doaj.org-article:ae6e053dfbe34d3e9cc1d7e603e5e231
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spelling	oai:doaj.org-article:ae6e053dfbe34d3e9cc1d7e603e5e2312021-11-16T19:01:42ZKlinische Sportmedizin0344-59252510-526410.5960/dzsm.2017.273https://doaj.org/article/ae6e053dfbe34d3e9cc1d7e603e5e2312017-03-01T00:00:00Zhttps://www.germanjournalsportsmedicine.com/archive/archive-2017/issue-3/hoehergradige-av-blockierungen-bei-einem-53-jaehrigen-triathleten-physiologisch-oder-pathologisch/https://doaj.org/toc/0344-5925https://doaj.org/toc/2510-5264The case of a second look concerning indication for pacemaker implantation due to advanced AV block in a 53-year-old master triathlete is reported. An extrinsic etiology (vagal induction) of the block seemed to be possible in the initial Holter-ECG. Therefore, further diagnostics followed. In repeated Holter-ECG, there was evidence for an at least partly intrinsic etiology of the blocks. This was supported by the MRT image of a previous myocarditis and the athlete`s age so that pacemaker implantation was also finally recommended.According to the Seattle criteria, advanced AV-blocks are unusual, not-training-induced ECG alterations, even in endurance-trained athletes. Pathogenically, an intrinsic etiology (direct AV nodal impairment) has to be distinguished from an extrinsic one (affection of electrophysiological characteristics by exogenous factors such as vagotonic increase in athletes). Several ECG-criteria are availablefor differentiation. However, the whole clinical picture has to be taken into account. Clarifying the cause of AV conduction disturbances is important as according to current guidelines of the European Society of Cardiology, etiology plays a role in decision-making concerning pacemaker indication. Possibly, there is no indication if the cause is purely extrinsic.Careful clinical evaluation of athletes presenting with advanced AV blocks, takingspecial sports-cardiological and rhythmological aspects into consideration for reliable confirmation of an intrinsic and not only extrinsic/vagally induced AV conduction disturbance is important in order to possibly prevent unnecessary pacemaker implantation.KEY WORDS: AV-Block, Athlete, Pacemaker, VagotoneLaszlo RRadermacher MLesevic HSteinacker JMDynamic Media Sales VerlagarticleSports medicineRC1200-1245DEENDeutsche Zeitschrift für Sportmedizin, Vol 68, Iss 3 (2017)
institution	DOAJ
collection	DOAJ
language	DE EN
topic	Sports medicine RC1200-1245
spellingShingle	Sports medicine RC1200-1245 Laszlo R Radermacher M Lesevic H Steinacker JM Klinische Sportmedizin
description	The case of a second look concerning indication for pacemaker implantation due to advanced AV block in a 53-year-old master triathlete is reported. An extrinsic etiology (vagal induction) of the block seemed to be possible in the initial Holter-ECG. Therefore, further diagnostics followed. In repeated Holter-ECG, there was evidence for an at least partly intrinsic etiology of the blocks. This was supported by the MRT image of a previous myocarditis and the athlete`s age so that pacemaker implantation was also finally recommended.According to the Seattle criteria, advanced AV-blocks are unusual, not-training-induced ECG alterations, even in endurance-trained athletes. Pathogenically, an intrinsic etiology (direct AV nodal impairment) has to be distinguished from an extrinsic one (affection of electrophysiological characteristics by exogenous factors such as vagotonic increase in athletes). Several ECG-criteria are availablefor differentiation. However, the whole clinical picture has to be taken into account. Clarifying the cause of AV conduction disturbances is important as according to current guidelines of the European Society of Cardiology, etiology plays a role in decision-making concerning pacemaker indication. Possibly, there is no indication if the cause is purely extrinsic.Careful clinical evaluation of athletes presenting with advanced AV blocks, takingspecial sports-cardiological and rhythmological aspects into consideration for reliable confirmation of an intrinsic and not only extrinsic/vagally induced AV conduction disturbance is important in order to possibly prevent unnecessary pacemaker implantation.KEY WORDS: AV-Block, Athlete, Pacemaker, Vagotone
format	article
author	Laszlo R Radermacher M Lesevic H Steinacker JM
author_facet	Laszlo R Radermacher M Lesevic H Steinacker JM
author_sort	Laszlo R
title	Klinische Sportmedizin
title_short	Klinische Sportmedizin
title_full	Klinische Sportmedizin
title_fullStr	Klinische Sportmedizin
title_full_unstemmed	Klinische Sportmedizin
title_sort	klinische sportmedizin
publisher	Dynamic Media Sales Verlag
publishDate	2017
url	https://doaj.org/article/ae6e053dfbe34d3e9cc1d7e603e5e231
work_keys_str_mv	AT laszlor klinischesportmedizin AT radermacherm klinischesportmedizin AT lesevich klinischesportmedizin AT steinackerjm klinischesportmedizin
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Klinische Sportmedizin

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