Retrospective Evaluation of Children Applying for Athlete Licenses

Yıl 2019, , 54 - 58, 15.06.2019

Nilüfer Çetiner , İbrahim Hakan Bucak , Habip Almış , Fedli Emre Kılıç Mehmet Turgut

https://doi.org/10.16948/zktipb.450625

Öz

Objective:
The numbers of children and adolescents taking part in sporting activities has
risen increasingly in recent years, but sudden deaths occurring during matches
or training are a cause for concern among families and in society. The purpose
of the study was to seek an answer to the question of whether children should
be evaluated by a pediatric cardiologist for sports licenses.

Material and Methods:
168 children aged 7-17 who had newly started sporting activities or doing sport
for some time were included in the study. Participants underwent a detailed
physical examination and were assessed by a pediatric cardiologist. Athletes
were examined using history, physical examination, 12-channel echocardiogram
and echocardiography.  Children with arrhythmia
were investigated using 24-h Holter monitoring.

Results:
168 cases, 136 (81%) boys and 32 (19%) girls  were enrolled. The mean age of the cases was 13 years. Pathology
was determined in 4.1% of all subjects at electrocardiogram and in 11.9% at echocardiography.
Effort tests were applied to 14 children with significant symptoms, in whom
arrhythmia was determined or with a family history, 24-h rhythm Holter monitoring
to five children and ambulatory Holter monitoring to one hypertensive child.
Holter monitoring revealed frequent isolated monomorphic ventricular premature
contraction in two subjects. Seven participants were eventually suspended from
sporting activities.

Conclusion:National
guidelines including presport cardiovascular evaluation have been developed in
order to prevent sports-related sudden deaths. The main conclusion from our
findings is that young children engaging in sports should be evaluated by a
pediatric cardiologist before starting sporting activities.

Anahtar Kelimeler

athletes, child, electrocardiogram, echocardiography, sudden death

Sporcu Lisansı İçin Başvuran Çocukların Retrospektif Değerlendirilmesi

Öz

Amaç: Spor faaliyetlerine katılan
çocukların ve ergenlerin sayısı son yıllarda giderek artmaktadır, ancak
müsabaka/ antreman sırasında meydana gelen ani ölümler aileler ve toplum
arasında endişe kaynağıdır. Bu çalışmanın amacı, çocuklara spor lisansı için
pediatrik kardiyolog tarafından değerlendirilmesi gerekir mi sorusuna bir cevap
aramaktı.

Materyal ve Metod:
Yaşları 7-17
arasında olan spora yeni başlamış 168 çocuk çalışmaya dahil edildi.
Katılımcılar detaylı bir fizik muayeneden geçirildi ve bir pediatrik kardiyolog
tarafından değerlendirildi. Sporcu çocuklar öykü, fizik muayene, 12
derivasyonlu elektrokardiyografi  ve
ekokardiyografi ile incelendi. Aritmi saptanan hastalar 24 saatlik Holter
monitörizasyonu ile araştırıldı.

Bulgular:
Çalışmada 136 (%81) erkek  ve 32 (%19) kız  toplam 168 olgu mevcuttu.  Olguların yaşları ortalaması 13 yıl
(7-17) idi. Tüm katılımcıların % 4,1’inde elektrokardiyogramda ve %
11,9’nda ekokardiyografide patoloji saptandı. Anlamlı şikayeti olan, aritmi
saptanan veya aile hikayesi olan 14 çocuğa efor testi, 5 çocuğa 24 saat ritim
Holter monitörizasyonu ve hipertansif olan 1 çocuğa 24 saat ambulatuar holter
monitörizasyon yapıldı. Holter monitörizasyonu katılımcıların 2’nde sık izole
monomorfik ventriküler erken atımı açığa çıkardı. Yedi katılımcı profesyonel
spor aktivitelerinden uzaklaştırıldı.

Sonuç: Spor aktivitelerine bağlı ani
ölümleri engellemek amacı ile spor öncesi kardiyovasküler değerlendirmeyi
içeren ulusal kılavuzlar geliştirilmelidir. Genç çocuk sporcuların spor aktivitelerine
başlamadan önce bir pediatrik kardiyolog tarafından değerlendirilmesi gerektiği
çalışmamızın ana sonucudur.

Anahtar Kelimeler

ani ölüm, çocuk, elektrokardiyogram, ekokardiyografi, sporcu

Kaynakça

• 1. Corrado D, Pelliccia A, Bjørnstad HH, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 2005; 26:516–524 .
• 2. Luckstead EF. Cardiac risk factors and participation guidelines for youth sports. Pediatr Clin N Am 2002; 49: 681-707.
• 3. Germann CA, Perron AD. Sudden cardiac death in athletes: a guide for emergency physicians. Am J Emerg Med 2005; 23: 504-509.
• 4. Akgün N. Sporda ani ölümler. Spor Hekimliği Dergisi 1985; 20:131–143.
• 5. Thompson PD, Estes III NAM: The athlete's heart. In: Textbook of Cardiovascular Medicine, 3rd (ed). Philadelphia: PA, Lippincott, Williams & Wilkins; 2007.
• 6. Kim JH, Malhotra R, Chiampas G, et al. Race Associated Cardiac Arrest Event Registry (RACER) Study Group. Cardiac arrest during long-distance running races. N Engl J Med. 2012; 366:130-140.
• 7. Maron BJ, Epstein SE, Roberts WC. Causes of sudden death in competitive athletes. J Am Coll Cardiol. 1986; 7 :204-214.
• 8. Corrado D, Basso C, Thiene G. Essay: Sudden death in athletes. Lancet 2005;366 :47-48.
• 9. Ostman-Smith I. Sudden Cardiac Death in Young Athletes. J Sports Med 2011; 2:85–97.
• 10. Maron BJ, Gohman TE, Aeppli D. Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes. J Am Coll Cardiol 1998; 32:1881–1884.
• 11. Maron BJ, Thompson PD, Ackerman MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 2007;115:1643–1655.
• 12. Halawa B. Cardiovascular diseases as a cause of sudden death in athletes. Pol Merkur Lekarski 2004; 16:5–7.
• 13. Maron BJ, Roberts WC, McAllister MH, Rosing DR, Epstein SE. Sudden death in young athletes. Circulation 1980; 62:218–229.
• 14. Thiene G, Nava A, Corrado D, Rossi L, Pennelli N. Right ventricular cardiomyopathy and sudden death in young people. N Engl J Med 1988; 318:129–133.
• 15. Burke AP, Farb A, Virmani R, Goodin J, Smialek JE. Sports-related and non-sports-related sudden cardiac death in young adults. Am Heart J 1991; 121:568–575.
• 16. Corrado D, Thiene G, Nava A, Pennelli N, Rossi L. Sudden death in young competitive athletes: clinico-pathologic correlations in 22 cases. Am J Med 1990;89:588–596.
• 17. Nava A, Bauce B, Basso C, et al. Clinical profile and long-term follow-up of 37 families with arrhythmogenic right ventricular cardiomyopathy. Am Coll Cardiol 2000; 36:2226–2233.
• 18. Corrado D, Basso C, Poletti A, Angelini A, Valente M, Thiene G. Sudden death in the young: is coronary thrombosis the majör precipitating factor? Circulation 1994; 90:2315–2323.
• 19. Seto CG. The preparticipation physical examination: an update. Clin Sports Med. 2011; 30:491-501.
• 20. Hirzinger C, Frolicher VF, Niebauer J. Pre-participation examination of competitive athletes: role of the ECG. Trends Cardiovasc Med. 2010; 20:195-199.
• 21. Patel A, Lantos JD. Can we prevent sudden cardiac death in young athletes? the debate about preparticipation sports screening. Acta Paediatr. 2011; 100:1287-1301.
• 22. Siddiqui S, Patel DR. Cardiovascular screening adolescent athletes. Pediatr Clin N Am. 2010; 57:635-647.
• 23. Pelliccia A. The preparticipation cardiovascular screening of competitive athletes: is it time to change the customary clinical practice? Eur Heart J 2007; 28: 2703–2705.
• 24. Myerson M, Sanchez-Ross M, Sherrid MV. Preparticipation athletic screening for genetic heart disease. Prog Cardiovasc Dis 2012; 54:543–552.
• 25. Maron BJ, Zipes DP. 36th Bethesda Conference Introduction: Eligibility recommendations for competitive athletes with cardiovascular abnormalities- General considerations. J Am Coll Cardiol 2005; 45: 1–64.