PDF(Pubmed)
Abstract：
UNASSIGNED: Middle-aged male athletes, with or without underlying coronary artery disease, exhibiting exercise induced blood pressure (BP) variability and diabetes can have an increased risk of developing atrial fibrillation (AF). Assessment in athletes should include long-term arrhythmia monitoring. In addition, it is important to exert patients beyond their calculated target heart rate (HR) during an exercise stress test to detect exercise-induced AF. We suggest this strategy be specifically used for athletes with complaints of intermittent palpitation and chest pain. Referral to an electrophysiologist for a possible ablation procedure should be considered for the management of AF in athletes in whom the use of beta-blockers may limit exercise tolerance. Bleeding risk with the use of oral anticoagulation needs to be adequately evaluated in athletes with AF who engage in high-intensity exercise or activities.
UNASSIGNED: The report highlights the case of a 54-year-old Caucasian male (height 5.11\', BMI 29.8) who presented with complaints of chest pain, mild coronary artery disease, palpitation, dizziness, and labile BP with high-intensity biking exercise. Diagnostic tests (exercise stress test, cardiac catheterization, Holter monitor, and Bardy patch) using standard procedure were unsuccessful at detecting the problem. In a repeat exercise stress test, the patient was exerted beyond the calculated HRmax (up to 117%) when the patient\'s heart rhythm flipped from sinus rhythm to AF. The patient was referred to a cardiac electrophysiologist and an ablation procedure was performed to prevent exercise-induced AF with high-intensity exercise. Young adults, with or without early coronary artery disease, performing high-intensity endurance exercises may be at risk of developing exercise-induced AF. This phenomenon is prevalent and well documented in the skiing population and patients with variance in BP during exercise. Endurance athletes tend to have a lower resting HR. As such, the use of standard rate-control medications in patients with exercise-induced AF may not be appropriate. Referral to a cardiac electrophysiologist and ablation procedures should be considered in this population for management and symptom control. If tolerated, especially in young adults with complaints of palpitation and chest pain, patients should be exerted beyond their calculated HRmax during an exercise stress test to diagnose an underlying condition of exercise-induced AF.
UNASSIGNED: The report highlights the case of a 54-year-old Caucasian male (height 5.11\', BMI 29.8) who presented with complaints of chest pain, mild coronary artery disease, palpitation, dizziness, and labile BP with high-intensity biking exercise. Diagnostic tests (exercise stress test, cardiac catheterization, Holter monitor, and Bardy patch) using standard procedure were unsuccessful at detecting the problem. In a repeat exercise stress test, the patient was exerted beyond the calculated HRmax (up to 117%) when the patient\'s heart rhythm flipped from sinus rhythm to AF. The patient was referred to a cardiac electrophysiologist and an ablation procedure was performed to prevent exercise-induced AF with high-intensity exercise. Young adults, with or without early coronary artery disease, performing high-intensity endurance exercises may be at risk of developing exercise-induced AF. This phenomenon is prevalent and well documented in the skiing population and patients with variance in BP during exercise. Endurance athletes tend to have a lower resting HR. As such, the use of standard rate-control medications in patients with exercise-induced AF may not be appropriate. Referral to a cardiac electrophysiologist and ablation procedures should be considered in this population for management and symptom control. If tolerated, especially in young adults with complaints of palpitation and chest pain, patients should be exerted beyond their calculated HRmax during an exercise stress test to diagnose an underlying condition of exercise-induced AF.
摘要：
■中年男运动员,有或没有潜在的冠状动脉疾病，表现出运动诱发的血压（BP）变异性和糖尿病可增加发生房颤（AF）的风险。运动员的评估应包括长期的心律失常监测。此外,重要的是在运动压力测试期间使患者超出其计算的目标心率（HR）以检测运动诱发的AF。我们建议该策略专门用于患有间歇性心悸和胸痛的运动员。对于使用β受体阻滞剂可能会限制运动耐量的运动员，应考虑转诊给电生理学家以进行可能的消融手术。对于从事高强度运动或活动的房颤运动员，需要充分评估使用口服抗凝药物的出血风险。
■该报告重点介绍了一名54岁的白人男性（身高5.11\'，BMI29.8）出现胸痛的患者，轻度冠状动脉疾病,心悸,头晕,和不稳定的血压与高强度自行车运动。诊断测试（运动压力测试，心导管插入术,Holter监护仪,和Bardy补丁）使用标准程序未能成功检测到问题。在重复运动压力测试中，当患者的心律从窦性心律转变为AF时，患者被施加超过计算的HRmax（高达117%）。患者被转诊给心脏电生理学家，并进行了消融手术，以防止高强度运动引起的房颤。年轻人,有或没有早期冠状动脉疾病，进行高强度耐力运动可能有发生运动诱发房颤的风险.这种现象在滑雪人群和运动过程中血压变化的患者中很普遍，有据可查。耐力运动员的静息HR往往较低。因此，在运动性房颤患者中使用标准的心率控制药物可能不合适.在该人群中，应考虑转诊给心脏电生理学家和消融程序，以进行管理和症状控制。如果容忍，尤其是在患有心悸和胸痛的年轻人中，在运动压力测试期间,患者应施加超出其计算的HRmax的力,以诊断运动诱发的AF的潜在状况.
■该报告重点介绍了一名54岁的白人男性（身高5.11\'，BMI29.8）出现胸痛的患者，轻度冠状动脉疾病,心悸,头晕,和不稳定的血压与高强度自行车运动。诊断测试（运动压力测试，心导管插入术,Holter监护仪,和Bardy补丁）使用标准程序未能成功检测到问题。在重复运动压力测试中，当患者的心律从窦性心律转变为AF时，患者被施加超过计算的HRmax（高达117%）。患者被转诊给心脏电生理学家，并进行了消融手术，以防止高强度运动引起的房颤。年轻人,有或没有早期冠状动脉疾病，进行高强度耐力运动可能有发生运动诱发房颤的风险.这种现象在滑雪人群和运动过程中血压变化的患者中很普遍，有据可查。耐力运动员的静息HR往往较低。因此，在运动性房颤患者中使用标准的心率控制药物可能不合适.在该人群中，应考虑转诊给心脏电生理学家和消融程序，以进行管理和症状控制。如果容忍，尤其是在患有心悸和胸痛的年轻人中，在运动压力测试期间,患者应施加超出其计算的HRmax的力,以诊断运动诱发的AF的潜在状况.
