Advertisement

Sport bei Kindern und Jugendlichen – kinderkardiologische Aspekte

  • Manfred Marx

Zusammenfassung

Die Sinnhaftigkeit der Durchführung einer sportmedizinischen Untersuchung vor einer leistungssportlichen Betätigung ist sowohl bei Erwachsenen als auch bei Kindern und Jugendlichen weitgehend unbestritten, gilt es doch, einen plötzlichen Herztod in Assoziation mit der sportlichen Belastung zu verhindern. Die kardiologische Interpretation darf jedoch nicht zu einer Verunsicherung der Probanden und auch nicht zu einer ausufernden Diagnostik führen. Ziel dieses Kapitels ist es, die altersentsprechenden physiologischen EKG-Veränderungen aufzuzeigen und die entsprechenden Unterschiede zum Erwachsenen-EKG heraus zu arbeiten. Spezielle Erkrankungen wie die hypertrophe Kardiomyopathie, angeborene Koronaranomalien, die arrhythmogene rechtsventrikuläre Kardiomyopathie, das Long-QT-Syndrom oder das WPW-Syndrom sind dargestellt. Die Extrasystolie, der plötzliche Thoraxschmerz sowie Empfehlungen zur sportlichen Betätigung von Patienten mit Vitien werden im Detail abgehandelt.

Literatur

  1. 1.
    Fleming S, Thompson M, Stevens R et al. (2011) Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet 377:1011–18CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kobza R, Cuculi F, Abächerli R, Toggweiler S, Suter Y, Frey F, Schmid JJ, Erne P (2012) Twelve-lead electrocardiography in the young: physiologic and pathologic abnormalities. Heart Rhythm 9(12):2018–22CrossRefPubMedGoogle Scholar
  3. 3.
    Villafañe J, Atallah J, Gollob MH, Maury P, Wolpert C, Gebauer R, Watanabe H, Horie M, Anttonen O, Kannankeril P, Faulknier B, Bleiz J, Makiyama T, Shimizu W, Hamilton RM, Young ML (2013) Long-term follow-up of a pediatric cohort with short QT syndrome. J Am Coll Cardiol Mar 19;61(11):1183–91CrossRefGoogle Scholar
  4. 4.
    Davignon A, Rautaharju P, Boisselle E, Soumis F, Megelas M, Choguette A (1979/80) Normal ECG standards for infants and children. Pediatr Cardiol 1: 123–31Google Scholar
  5. 5.
    Rijnbeek PR, Witsenburg M, Schrama E et al. (2001) New normal limits for the paediatric electrocardiogram. Eur Heart J 22:702–11CrossRefPubMedGoogle Scholar
  6. 6.
    Rijnbeek PR, van Herpen G, Kapusta L et al. (2008) Electrocardiographic criteria for left ventricular hypertrophy in children. Pediatr Cardiol 29:923–8CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Killian L, Simpson JM, Savis A, Rawlins D, Sinha MD (2010) Electrocardiography is a poor screening test to detect left ventricular hypertrophy in children. Arch Dis Child 95(10):832–6CrossRefPubMedGoogle Scholar
  8. 8.
    Roston TM, De Souza AM, Sandor GG, Sanatani S, Potts JE (2013) Physical activity recommendations for patients with electrophysiologic and structural congenital heart disease: a survey of Canadian health care providers. Pediatr Cardiol 34(6):1374–81CrossRefPubMedGoogle Scholar
  9. 9.
    Maron BJ (2003) Sudden death in young athletes. N Engl J Med 2003;349:1064–1075CrossRefPubMedGoogle Scholar
  10. 10.
    Maron BJ, Gardin JM, Flack JM et al. (1995) Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the CARDIA Study. Circulation 92:785–9CrossRefPubMedGoogle Scholar
  11. 11.
    Basavarajaiah S, Wilson M, Whyte G et al. (2008) Prevalence of hypertrophic cardiomyopathy in highly trained athletes. J Am Coll Cardiol 51:1033–9CrossRefPubMedGoogle Scholar
  12. 12.
    Rowin EJ, Maron BJ, Appelbaum E, Link MS, Gibson CM, Lesser JR, Haas TS, Udelson JE, Manning WJ, Maron MS (2012) Significance of false negative electrocardiograms in preparticipation screening of athletes for hypertrophic cardiomyopathy. Am J Cardiol 1;110(7):1027–32CrossRefGoogle Scholar
  13. 13.
    Maron BJ, Ackerman MJ, Nishimura RA et al. (2005) Task Force 4: HCM and Other Cardiomyopathies, Mitral Valve Prolapse, Myocarditis, and Marfan Syndrome. J Am Coll Cardiol 45(8):1340–5CrossRefPubMedGoogle Scholar
  14. 14.
    Maron BJ, Ackerman MJ, Nishimura RA et al. (2005) Task Force 4: HCM and Other Cardiomyopathies, Mitral Valve Prolapse, Myocarditis, and Marfan Syndrome. J Am Coll Cardiol 45(8):1340–5CrossRefPubMedGoogle Scholar
  15. 15.
    Pelliccia A, Zipes DP, Maron BJ (2008) Bethesda Conference #36 and the European Society of Cardiology Consensus recommendations revisited: a comparison of U.S. and European criteria for eligibility and disqualification of competitive athletes with cardiovascular abnormalities. Journal of the American College of Cardiology 52(24):1990–1996CrossRefPubMedGoogle Scholar
  16. 16.
    Maron BJ, Chaitman BR, Ackerman MJ et al. (2004) Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation 109:2807–16CrossRefPubMedGoogle Scholar
  17. 17.
    Angelini P (2007) Coronary artery anomalies. An entity in search of an identity. Circulation 115:1296–305PubMedGoogle Scholar
  18. 18.
    Graham TP, Driscoll DJ, Gersony WM et al. (2005) Task Force 2: Congenital Heart Disease. J Am Coll Cardiol 45:1326–33CrossRefPubMedGoogle Scholar
  19. 19.
    Peters S, Trummel M, Meyners W (2004) Prevalence of right ventricular dysplasia/cardiomyopathy in a nonreferral hospital. Int J Cardiol 97:499–501CrossRefPubMedGoogle Scholar
  20. 20.
    Tabib A, Chalabreysse L, Barel C et al. (2003) Circumstances of death and gross and microscopic observations in a series of 200 cases of sudden death associated with arrhythmogenic right ventricular cardiomyopathy and/or dysplasia. Circulation 108:3000–3005CrossRefPubMedGoogle Scholar
  21. 21.
    Marcus FI, McKenna WJ, Sherrill D et al. (2010) Diagnosis of arrhythmogenic right ventricular cardiomyopathy/ dysplasia. Eur Heart J 31:806–814CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Marcus FI (2005) Prevalence of T-wave inversion beyond V1 in young normal individuals and usefulness for the diagnosis of arrhythmogenic right ventricular cardiomyopathy/ dysplasia. Am J Cardiol 95:1070–1071CrossRefPubMedGoogle Scholar
  23. 23.
    Morin DP, Mauer AC, Gear K, Zareba W, Markowitz SM, Marcus FI, Lerman BB (2010) Usefulness of precordial T-wave inversion to distinguish arrhythmogenic right ventricular cardiomyopathy from idiopathic ventricular tachycardia arising from the right ventricular outflow tract. Am. J. Cardiol 2010;105, 1821–1824Google Scholar
  24. 24.
    Hoffmayer KS, Machado ON, Marcus GM, Yang Y, Johnson CJ, Ermakov S, Vittinghoff E, Pandurangi U, Calkins H, Cannom D, Gear KC, Tichnell C, Park Y, Zareba W, Marcus FI, Scheinman MM (2011) Electrocardiographic comparison of ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy and right ventricular outflow tract tachycardia. J. Am. Coll. Cardiol 58, 831–838CrossRefPubMedGoogle Scholar
  25. 25.
    Fogel MA, Weinberg PM, Harris M, Rhodes L (2006) Usefulness of magnetic resonance imaging for the diagnosis of right ventricular dysplasia in children. Am J Cardiol 97:1232–7CrossRefPubMedGoogle Scholar
  26. 26.
    Yoo SJ, Grosse-Wortmann L, Hamilton RM (2010) Magnetic resonance imaging assessment of arrhythmogenic right ventricular cardiomyopathy/dysplasia in children. Korean Circ J 40(8):357–67CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Corrado D, Basso C, Rizzoli G et al. (2003) Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol 42:1959–63CrossRefPubMedGoogle Scholar
  28. 28.
    Ackerman MJ (2004) Cardiac channelopathies: it's in the genes. Nat Med 10:463–4CrossRefPubMedGoogle Scholar
  29. 29.
    Schwartz PJ, Stramba-Badiale M, Crotti L, Pedrazzini M, Besana A, Bosi G, Gabbarini F, Goulene K, Insolia R, Mannarino S, Mosca F, Nespoli L, Rimini A, Rosati E, Salice P, Spazzolini C (2009) Prevalence of the congenital long-QT syndrome. Circulation 120:1761–1767CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Hedley PL, Jørgensen P, Schlamowitz S, Wangari R, Moolman- Smook J, Brink PA, Kanters JK, Corfield VA, Christiansen M (2009) The genetic basis of long QT and short QT syndromes: a mutation update. Hum Mutat 30:1486–1511CrossRefPubMedGoogle Scholar
  31. 31.
    Liu JF, Jons C, Moss AJ et al. (2011) Risk factors for recurrent syncope and subsequent fatal or near-fatal events in children and adolescents with long QT syndrome. J Am Coll Cardiol 57:941–50CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Zipes DP, Ackerman MJ, Estes NA 3rd. et al. (2005) Task force 7: arrhythmias. J Am Coll Cardiol 45:1354–63CrossRefPubMedGoogle Scholar
  33. 33.
    Johnson JN, Ackerman MJ (2013) Return to play? Athletes with congenital long QT syndrome. Br J Sports Med 47: 28–33CrossRefPubMedGoogle Scholar
  34. 34.
    Kambara H, Phillips J (1976) Long-term evaluation of early repolarization syndrome (normal variant RS-T segment elevation). Am J Cardiol 38:156–57CrossRefGoogle Scholar
  35. 35.
    Sinner MF, Reinhard W, Muller M et al. (2010) Association of early repolarization pattern on ECG with risk of cardiac and all-cause mortality: a population-based prospective cohort study (MONICA/KORA). PLoS Med 7:e1000314CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Rosso R, Adler A, Halkin A, Viskin S (2011) Risk of sudden death among young individuals with J waves and early repolarization: putting the evidence into perspective. Heart Rhythm 8:923–929CrossRefPubMedGoogle Scholar
  37. 37.
    Walsh JA III, Ilkhanoff L, Soliman EZ, et al. (2013) Natural history of the early repolarization pattern in a biracial cohort: CARDIA (Coronary Artery Risk Development in Young Adults) study. J Am Coll Cardiol 61:863–9CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Noseworthy PA, Tikkanen JT, Porthan K et al. (2011) The early repolarization pattern in the general population: clinical correlates and heritability. J Am Coll Cardiol 57:2284–9CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Haissaguerre M, Derval N, Sacher F et al. (2008) Sudden cardiac arrest associated with early repolarization. N Engl J Med 358:2016–23CrossRefPubMedGoogle Scholar
  40. 40.
    Cappato R, Furlanello F, Giovinazzo V et al. (2010) J wave, QRS slurring and ST elevation in athletes with cardiac arrest in the absence of heart disease: marker of risk or innocent bystander? Circ Arrhythm Electrophysiol 3:305–11CrossRefPubMedGoogle Scholar
  41. 41.
    Gussak I, Antzelevitch C (2000) Early repolarization syndrome: clinical characteristics and possible cellular and ionic mechanisms. J Electrocardiol 33:299CrossRefPubMedGoogle Scholar
  42. 42.
    Tikkanen JT, Junttila MJ, Anttonen O et al. (2011) Early repolarization: electrocardiographic phenotypes associated with favorable long-term outcome. Circulation 123:2666CrossRefPubMedGoogle Scholar
  43. 43.
    Gussak I, Antzelevitch C (2013) Early repolarization syndrome: A decade of progress. J Electrocardiol 46(2):110–3CrossRefPubMedGoogle Scholar
  44. 44.
    RG Hiss, LE Lamb (1962) Electrocardiographic findings in 122,043 individuals. Circulation 25:947–961CrossRefPubMedGoogle Scholar
  45. 45.
    Chung KY, Walsh TJ, Massie E (1965) Wolff-Parkinson- White Sydrome. Am Heart J 69:116–33CrossRefPubMedGoogle Scholar
  46. 46.
    Dreifus LS, Haiat R, Watanabe Y et al. (1971) Ventricular fibrillation. A possible mechanism of sudden death in patients and Wolff-Parkinson-White syndrome. Circulation 43:520–7CrossRefPubMedGoogle Scholar
  47. 47.
    Munger TM, Packer DL, Hammill SC, Feldman BJ, Bailey KR, Ballard DJ, Holmes DR Jr, Gersh BJ (1993) A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989. Circulation 87:866–873CrossRefPubMedGoogle Scholar
  48. 48.
    Sen-Chowdhry S, McKenna WJ (2006) Sudden cardiac death in the young: a strategy for prevention by targeted evaluation. Cardiology 105:196–206CrossRefPubMedGoogle Scholar
  49. 49.
    Driscoll DJ, Edwards WD (1985) Sudden unexpected death in children and adolescents. J Am Coll Cardiol 5:118B–21CrossRefPubMedGoogle Scholar
  50. 50.
    Liberthson RR (1996) Sudden death from cardiac causes in children and young adults. N Engl J Med 334:1039–44CrossRefPubMedGoogle Scholar
  51. 51.
    Timmermans C, Smeets JLRM, Rodriguez LM et al. (1995) Aborted sudden death in the Wolff-Parkinson-White syndrome. Am J Cardiol 76:492–4CrossRefPubMedGoogle Scholar
  52. 52.
    Klein GJ, Yee R, Sharma AD (1989) Longitudinal electrophysiologic assessment of asymptomatic patients with the Wolff-Parkinson-White electrocardiographic pattern. N Engl J Med 320:1229–1233CrossRefPubMedGoogle Scholar
  53. 53.
    Goudevenos JA, Katsouras CS, Graekas G, Argiri O, Giogiakas V, Sideris DA (2000) Ventricular pre-excitation in the general population: a study on the mode of presentation and clinical course. Heart 83:29–34CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Wellens HJ (2005) Should catheter ablation be performed in asymptomatic patients with Wolff-Parkinson-White syndrome? When to perform catheter ablation in asymptomatic patients with a Wolff-Parkinson-White electrocardiogram. Circulation 112:2201–2207CrossRefPubMedGoogle Scholar
  55. 55.
    Weng KP, Wolff GS, Young ML (2003) Multiple accessory pathways in pediatric patients with Wolff-Parkinson- White syndrome. Am J Cardiol 91:1178–1183CrossRefPubMedGoogle Scholar
  56. 56.
    Daubert C, Ollitrault J, Descaves C, Mabo P, Ritter P, Gouffault J (1988) Failure of the exercise test to predict the anterograde refractory period of the accessory pathway in Wolff Parkinson White syndrome. Pacing Clin Electrophysiol 11:1130–1138CrossRefPubMedGoogle Scholar
  57. 57.
    Cohen MI, Triedman JK, Cannon BC, Davis AM, Drago F, Janousek J, Klein GJ, Law IH, Morady FJ, Paul T, Perry JC, Sanatani S, Tanel RE (20121) PACES/HRS Expert Consensus Statement on the Management of the Asymptomatic Young Patient with a Wolff-Parkinson-White (WPW, Ventricular Preexcitation) Electrocardiographic Pattern: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS). Heart Rhythm 9:1006–1024Google Scholar
  58. 58.
    Friedman RA, Walsh EP, Silka MJ, Calkins H, Stevenson WG, Rhodes LA, Deal BJ, Wolff GS, Demaso DR, Hanisch D, van Hare GF (2002) NASPE Expert Consensus Conference: Radiofrequency catheter ablation in children with and without congenital heart disease. Report of the writing committee. North American Society of Pacing and Electrophysiology. Pacing Clin Electrophysiol 25:1000–1017PubMedGoogle Scholar
  59. 59.
    Campbell RM, Strieper MJ, Frias PA, Collins KK, Van Hare GF, Dubin AM (2003) Survey of current practice of pediatric electrophysiologists for asymptomatic Wolff-Parkinson- White syndrome. Pediatrics 111:e245–e247CrossRefPubMedGoogle Scholar
  60. 60.
    Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO (2009) Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation 119:1085–1092CrossRefPubMedGoogle Scholar
  61. 61.
    Corrado D, Pelliccia A, Bjornstad HH, Vanhees L, Biffi A, Borjesson M, Panhuyzen-Goedkoop N, Deligiannis A, Solberg E, Dugmore D, Mellwig KP, Assanelli D, Delise P, van-Buuren F, Anastasakis A, Heidbuchel H, Hoffmann E, Fagard R, Priori SG, Basso C, Arbustini E, Blomstrom- Lundqvist C, McKenna WJ, Thiene G (2005) 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 26:516–524CrossRefPubMedGoogle Scholar
  62. 62.
    Brodsky M, Wu D, Denes P, Kanakis Ch, Rosen KM (1977) Arrhythmias documented by 24-hour continuous electrocardiographic monitoring in 50 male medical students without apparent heart disease. Am J Cardiol 39:390–5CrossRefPubMedGoogle Scholar
  63. 63.
    Sobotka PA, Mayer JH, Bauernfeind RA et al. (1981) Arrhythmias documented by 24-hour continuous ambulatory electrocardiographic monitoring in young women without apparent heart disease. Am Heart J 101:753–9CrossRefPubMedGoogle Scholar
  64. 64.
    Folarin VA, Fitzsimmons PJ, Kruyer WB (2001) Holter monitor findings in asymptomatic male military aviators without structural heart disease. Aviat Space Environ Med 72:836–8PubMedGoogle Scholar
  65. 65.
    Southall DP, Johnston F, Shinebourne EA, Johnston PG (1981) 24-hour electrocardiographic study of heart rate and rhythm patterns in population of healthy children. Br Heart J 45(3):281–91CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Kakavand B, Ballard HO, Disessa TG (2010) Frequent ventricular premature beats in children with a structurally normal heart: a cause for reversible left ventricular dysfunction? Pediatr Cardiol 31(7):986–90CrossRefPubMedGoogle Scholar
  67. 67.
    Gami AS, Noheria A, Lachman N, Edwards WD, Friedman PA, Talreja D, Hammill SC, Munger TM, Packer DL, Asirvatham SJ (2011) Anatomical correlates relevant to ablation above the semilunar valves for the cardiac electrophysiologist: a study of 603 hearts. J Interv Card Electrophysiol 30(1):5–15CrossRefPubMedGoogle Scholar
  68. 68.
    Beaufort-Krol GC, Dijkstra SS, Bink-Boelkens MT (2008) Natural history of ventricular premature contractions in children with a structurally normal heart: does origin matter? Europace 10(8):998–1003CrossRefPubMedGoogle Scholar
  69. 69.
    M. Marx, S. Albinni, D. Luckner (2013) Die Extrasystolie. Ein Phänomen in jedem Lebensalter. Kinder- und Jugendmedizin 13 (1):21–27Google Scholar
  70. 70.
    Biffi A, Pelliccia A, Verdile L et al. (2002) Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trainedathletes. J Am Coll Cardiol 40: 446–52CrossRefPubMedGoogle Scholar
  71. 71.
    Biffi A, Maron BJ et al. (2011) Patterns of Ventricular Tachyarrhythmias Associated WithTraining, Deconditioning and Retraining in Elite Athletes Without Cardiovascular Abnormalities. Am J Cardiol 107:697–703CrossRefPubMedGoogle Scholar
  72. 72.
    Heidbuchel H, Corrado D, Biffi A et al. (2006) Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part II: ventricular arrhythmias channelopathies and implantable defibrillators. Eur J Cardiovasc Prev Rehabil 13:676–686CrossRefPubMedGoogle Scholar
  73. 73.
    Fredriksen PM, Kahrs N, Blaasvaer S, Sigurdsen E, Gundersen O, Roeksund O, Norgaard G, Vik JT, Soerye O, Ingjer F, Thaulow E (2000) Effect of physical training in children and adolescents with congenital heart disease- Cardiol Young 10:107–114PubMedGoogle Scholar
  74. 74.
    Rhodes J, Curran TJ, Camil L, Rabideau N, Fulton DR, Gauthier NS, Gauvreau K, Jenkins KJ (2005) Impact of cardiac rehabilitation on the exercise function of children with serious congenital heart disease. Pediatrics 116: 1339–1345CrossRefPubMedGoogle Scholar
  75. 75.
    Budts W, Börjesson M, Chessa M, van Buuren F, Trindade PT, Corrado D, Heidbuchel H, Webb G, Holm J, Papadakis M (2013) Physical activity in adolescents and adults with congenital heart defects: individualized exercise prescription. European Heart Journal 34, 3669–3674CrossRefPubMedGoogle Scholar
  76. 76.
    Takken T, Giardini A, Reybrouck T et al. (2012) Recommendations for physical activity, recreation sport, and exercise training in paediatric patients with congenital heart disease: a report from the Exercise, Basic & Translational Research Section of the European Association of Cardiovascular Prevention and Rehabilitation, the European Congenital Heart and Lung Exercise Group, and the Association for European Paediatric Cardiology. European Journal of Preventive Cardiology October 19: 1034–1065CrossRefGoogle Scholar
  77. 77.
    Mitchell JH, Haskell W, Snell P, Van Camp SP (2005) Task force 8: classification of sports. J Am Coll Cardiol 45:1364–7CrossRefPubMedGoogle Scholar
  78. 78.
    Drossner DM, Hirsh DA, Sturm JJ, Mahle WT, Goo DJ, Massey R, Simon HK (2011) Cardiac disease in pediatric patients presenting to a pediatric ED with chest pain. Am J Emerg Med 29(6):632–8CrossRefPubMedGoogle Scholar
  79. 79.
    Saleeb SF, Li WYV, Warren SZ, Lock JE (2011) Effectiveness of Screening for Life-Threatening Chest Pain in Children. Pediatrics 128:e1062Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Manfred Marx
    • 1
  1. 1.Medizinische Universität WienAKH WienWien

Personalised recommendations