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Article: The Acute Effects of an Ultramarathon on Atrial Function and Supraventricular Arrhythmias in Master Athletes.

Cavigli, Luna / Zorzi, Alessandro / Spadotto, Veronica / Mandoli, Giulia Elena / Melani, Andrea / Fusi, Chiara / D'Andrea, Antonello / Focardi, Marta / Valente, Serafina / Cameli, Matteo / Bonifazi, Marco / D'Ascenzi, Flavio

Journal of clinical medicine

2022 Volume 11, Issue 3

Abstract: Background: Endurance sports practice has significantly increased over the last decades, with a growing proportion of master athletes. However, concerns exist regarding the potential proarrhythmic effects induced by ultra-endurance sports. This study ... ...

Abstract	Background: Endurance sports practice has significantly increased over the last decades, with a growing proportion of master athletes. However, concerns exist regarding the potential proarrhythmic effects induced by ultra-endurance sports. This study aimed to analyse the acute effects of an ultramarathon race on atrial remodelling and supraventricular arrhythmias in a population of master athletes. Methods: Master athletes participating in an ultramarathon (50 km, 600 m of elevation gain) with no history of heart disease were recruited. A single-lead ECG was recorded continuously from the day before to the end of the race. Echocardiography and 12-lead resting ECG were performed before and immediately at the end of the race. Results: The study sample consisted of 68 healthy non-professional master athletes. Compared with baseline, P wave voltage was higher after the race ( Conclusions: In master athletes running an ultramarathon, acute exercise-induced atrial dysfunction was not detected, and exercise-induced supraventricular arrhythmias were uncommon. These results did not confirm the hypothesis of an acute atrial dysfunction induced by ultra-endurance exercise.
Language	English
Publishing date	2022-01-20
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11030528
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Article ; Online: The concept of double inlet-double outlet right ventricle: a distinct congenital heart disease.

Spadotto, Veronica / Frescura, Carla / Ho, Siew Yen / Thiene, Gaetano

Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology

2017 Volume 26, Page(s) 39–44

Abstract: The aim of this study was to estimate the incidence and to analyze the anatomy of double inlet-double outlet right ventricle complex and its associated cardiac anomalies in our autopsy series. Among the 1640 hearts with congenital heart disease of our ... ...

Abstract	The aim of this study was to estimate the incidence and to analyze the anatomy of double inlet-double outlet right ventricle complex and its associated cardiac anomalies in our autopsy series. Among the 1640 hearts with congenital heart disease of our Anatomical Collection, we reviewed the specimens with double inlet-double outlet right ventricle, according to the sequential-segmental analysis, identifying associated cardiac anomalies and examining lung histology to assess the presence of pulmonary vascular disease. We identified 14 hearts with double inlet-double outlet right ventricle (0.85%). Right atrial isomerism was observed in 10 hearts, situs solitus in 3 and left atrial isomerism in one. Regarding the mode of atrioventricular connection, all hearts but one had a common atrioventricular valve. Systemic or pulmonary venous abnormalities were noted in all patients with atrial isomerism. In nine patients a valvular or subvalvular pulmonary stenosis was present. Among the functionally "univentricular hearts", double inlet- double outlet right ventricle represents a peculiar entity, mostly in association with right atrial isomerism. Multiple cardiac anomalies are associated and may complicate surgical repair.
MeSH term(s)	Adolescent ; Adult ; Child ; Child, Preschool ; Double Outlet Right Ventricle/epidemiology ; Double Outlet Right Ventricle/pathology ; Female ; Heart Ventricles/abnormalities ; Humans ; Infant ; Infant, Newborn ; Male ; Young Adult
Language	English
Publishing date	2017-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	1134600-0
ISSN	1879-1336 ; 1054-8807
ISSN (online)	1879-1336
ISSN	1054-8807
DOI	10.1016/j.carpath.2016.09.003
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Article: Response to: Coronary artery systolic "milking" and "bridging" in Takotsubo syndrome: substrate or an epiphenomenon?

Migliore, Federico / Zorzi, Alessandro / Spadotto, Veronica / Elmaghawry, Mohamed / Tarantini, Giuseppe

Global cardiology science & practice

2014 Volume 2014, Issue 1, Page(s) 100

Language	English
Publishing date	2014-01-29
Publishing country	Qatar
Document type	Journal Article
ZDB-ID	2738381-7
ISSN	2305-7823
ISSN	2305-7823
DOI	10.5339/gcsp.2014.17
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Article ; Online: The Acute Effects of an Ultramarathon on Atrial Function and Supraventricular Arrhythmias in Master Athletes

Luna Cavigli / Alessandro Zorzi / Veronica Spadotto / Giulia Elena Mandoli / Andrea Melani / Chiara Fusi / Antonello D’Andrea / Marta Focardi / Serafina Valente / Matteo Cameli / Marco Bonifazi / Flavio D’Ascenzi

Journal of Clinical Medicine, Vol 11, Iss 528, p

2022 Volume 528

Abstract: Background. Endurance sports practice has significantly increased over the last decades, with a growing proportion of master athletes. However, concerns exist regarding the potential proarrhythmic effects induced by ultra-endurance sports. This study ... ...

Abstract	Background. Endurance sports practice has significantly increased over the last decades, with a growing proportion of master athletes. However, concerns exist regarding the potential proarrhythmic effects induced by ultra-endurance sports. This study aimed to analyse the acute effects of an ultramarathon race on atrial remodelling and supraventricular arrhythmias in a population of master athletes. Methods. Master athletes participating in an ultramarathon (50 km, 600 m of elevation gain) with no history of heart disease were recruited. A single-lead ECG was recorded continuously from the day before to the end of the race. Echocardiography and 12-lead resting ECG were performed before and immediately at the end of the race. Results. The study sample consisted of 68 healthy non-professional master athletes. Compared with baseline, P wave voltage was higher after the race ( p < 0.0001), and more athletes developed ECG criteria for right atrial enlargement ( p < 0.0001). Most of the athletes (97%) had ≥1 premature atrial beats (PAB) during the 24-h monitoring, also organised in triplets (17%) and non-sustained supraventricular tachycardias (NSSVTs) (19%). In contrast, exercise-induced PABs, triplets, and NSSVTs were rare. One athlete developed acute atrial fibrillation during the race. After the race, no significant differences were found in biatrial dimensions. Biatrial function, estimated by peak atrial longitudinal and contraction strains, were normal both before and after the race. Conclusions. In master athletes running an ultramarathon, acute exercise-induced atrial dysfunction was not detected, and exercise-induced supraventricular arrhythmias were uncommon. These results did not confirm the hypothesis of an acute atrial dysfunction induced by ultra-endurance exercise.
Keywords	endurance ; right atrium ; left atrium ; athlete’s heart ; master athletes ; arrhythmias ; Medicine ; R
Subject code	796
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: L’arresto cardiaco negli impianti sportivi nel 2015: possibili implicazioni epidemiologiche dell’applicazione della “Legge Balduzzi”.

Zorzi, Alessandro / Susana, Angela / Spadotto, Veronica / Cacciavillani, Luisa / Corrado, Domenico

Giornale italiano di cardiologia (2006)

2016 Volume 17, Issue 11, Page(s) 903–907

Abstract: Under the Italian Law "Legge Balduzzi", which was issued after the sudden cardiac death of professional athletes Pier Mario Morosini and Vigor Bovolenta in 2012, the presence of an automated external defibrillator (AED) and personnel trained to perform ... ...

Title translation	Sudden cardiac arrest in Italian sports facilities in 2015: epidemiological implications of the so-called "Balduzzi decree".
Abstract	Under the Italian Law "Legge Balduzzi", which was issued after the sudden cardiac death of professional athletes Pier Mario Morosini and Vigor Bovolenta in 2012, the presence of an automated external defibrillator (AED) and personnel trained to perform cardiopulmonary resuscitation must be available in every Italian sports facility from 2016. In 2015 the national and local press reported 123 cases of sudden cardiac arrests (SCA) occurring in Italian sport facilities, corresponding to an estimated ≈0.2-0.4% of all SCA and to ≈0.6-1.2% of SCA in public places. The majority of SCA victims were males (93%) and >35 years old (88%, median age 50 years). On the basis of the report of the event on the press, the rate of return of spontaneous circulation was 62% when an AED was used before emergency medical system arrival versus 9% when no bystander cardiopulmonary resuscitation or AED use by lay rescuers was mentioned. These data demonstrated that the Law has the potential to increase the survival to SCA in athletes; however, limiting the obligation of the presence of an AED only to sports facilities is not enough to decrease significantly the incidence of SCA in the general population.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Athletes ; Cardiopulmonary Resuscitation/methods ; Child ; Death, Sudden, Cardiac/epidemiology ; Death, Sudden, Cardiac/prevention & control ; Defibrillators/supply & distribution ; Female ; Heart Arrest/epidemiology ; Heart Arrest/therapy ; Humans ; Incidence ; Italy ; Male ; Middle Aged ; Sports/legislation & jurisprudence ; Young Adult
Language	Italian
Publishing date	2016-11
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2272414-X
ISSN	1972-6481 ; 1827-6806
ISSN (online)	1972-6481
ISSN	1827-6806
DOI	10.1714/2498.26192
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Zs.A 6738: Show issues

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Article ; Online: Successful Bentall procedure in a patient with a Fontan circulation.

Spadotto, Veronica / Uemura, Hideki / Uebing, Anselm

Interactive cardiovascular and thoracic surgery

2014 Volume 19, Issue 3, Page(s) 520–522

Abstract: A 33-year old male patient with absent left atrioventricular connection and double outlet left ventricle developed severe aortic root dilatation and aortic regurgitation. He had undergone initial banding of the pulmonary trunk and atrial septectomy, ... ...

Abstract	A 33-year old male patient with absent left atrioventricular connection and double outlet left ventricle developed severe aortic root dilatation and aortic regurgitation. He had undergone initial banding of the pulmonary trunk and atrial septectomy, eventually followed by the bidirectional Glenn procedure. At the time of the total cavopulmonary connection (at 27 years of age), his ascending aorta was plicated and wrapped. Subsequently, the aortic root below the wrapped ascending aorta showed further dilatation. The Bentall procedure was successfully carried out.
MeSH term(s)	Abnormalities, Multiple ; Adult ; Aorta/pathology ; Aorta/physiopathology ; Aorta/surgery ; Aortic Aneurysm/diagnosis ; Aortic Aneurysm/etiology ; Aortic Aneurysm/physiopathology ; Aortic Aneurysm/surgery ; Aortic Valve/physiopathology ; Aortic Valve/surgery ; Aortic Valve Insufficiency/diagnosis ; Aortic Valve Insufficiency/etiology ; Aortic Valve Insufficiency/physiopathology ; Aortic Valve Insufficiency/surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/instrumentation ; Dilatation, Pathologic ; Fontan Procedure ; Heart Defects, Congenital/complications ; Heart Defects, Congenital/diagnosis ; Heart Defects, Congenital/surgery ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation/instrumentation ; Heart Ventricles/abnormalities ; Heart Ventricles/surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Prosthesis Design ; Reoperation ; Tomography, X-Ray Computed ; Treatment Outcome
Language	English
Publishing date	2014-09
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivu163
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Article ; Online: The acute effects of an ultramarathon on biventricular function and ventricular arrhythmias in master athletes.

Cavigli, Luna / Zorzi, Alessandro / Spadotto, Veronica / Gismondi, Annalaura / Sisti, Niccolò / Valentini, Francesca / Anselmi, Francesca / Mandoli, Giulia Elena / Spera, Lucia / Di Florio, Alex / Baccani, Bernardo / Cameli, Matteo / D'Ascenzi, Flavio

European heart journal. Cardiovascular Imaging

2021 Volume 23, Issue 3, Page(s) 423–430

Abstract: Aims: Endurance sports practice has significantly increased over the last decades, with a growing proportion of participants older than 40 years. Although the benefits of moderate regular exercise are well known, concerns exist regarding the potential ... ...

Abstract	Aims: Endurance sports practice has significantly increased over the last decades, with a growing proportion of participants older than 40 years. Although the benefits of moderate regular exercise are well known, concerns exist regarding the potential negative effects induced by extreme endurance sport. The aim of this study was to analyse the acute effects of an ultramarathon race on the electrocardiogram (ECG), biventricular function, and ventricular arrhythmias in a population of master athletes. Methods and results: Master athletes participating in an ultramarathon (50 km, 600 m of elevation gain) with no history of heart disease were recruited. A single-lead ECG was recorded continuously from the day before to the end of the race. Echocardiography and 12-lead resting ECG were performed before and at the end of the race. The study sample consisted of 68 healthy non-professional master athletes. Compared with baseline, R-wave amplitude in V1 and QTc duration were higher after the race (P < 0.001). Exercise-induced isolated premature ventricular beats were observed in 7% of athletes; none showed non-sustained ventricular tachycardia before or during the race. Left ventricular ejection fraction, global longitudinal strain (GLS), and twisting did not significantly differ before and after the race. After the race, no significant differences were found in right ventricular inflow and outflow tract dimensions, fractional area change, s', and free wall GLS. Conclusion: In master endurance athletes running an ultra-marathon, exercise-induced ventricular dysfunction, or relevant ventricular arrhythmias was not detected. These results did not confirm the hypothesis of a detrimental acute effect of strenuous exercise on the heart.
MeSH term(s)	Arrhythmias, Cardiac/diagnostic imaging ; Arrhythmias, Cardiac/etiology ; Athletes ; Humans ; Physical Endurance ; Stroke Volume ; Ventricular Function, Left ; Ventricular Function, Right
Language	English
Publishing date	2021-02-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2638345-7
ISSN	2047-2412 ; 2047-2404
ISSN (online)	2047-2412
ISSN	2047-2404
DOI	10.1093/ehjci/jeab017
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Article: Juxtaposition of the atrial appendages: A nidus for thrombus in atriopulmonary Fontan?

Spadotto, Veronica / Voges, Inga / Kilner, Philip J / Yacoub, Magdi H / Ernst, Sabine / Ho, Siew Yen / Babu-Narayan, Sonya V

Global cardiology science & practice

2016 Volume 2016, Issue 2, Page(s) e201619

Abstract: Juxtaposition of atrial appendages is a rare cardiac congenital anomaly, usually associated with other cardiac malformations. Until now, it has not been linked to any significant clinical implications. We report cardiovascular magnetic resonance (CMR) ... ...

Abstract	Juxtaposition of atrial appendages is a rare cardiac congenital anomaly, usually associated with other cardiac malformations. Until now, it has not been linked to any significant clinical implications. We report cardiovascular magnetic resonance (CMR) findings of two adult patients who underwent atriopulmonary Fontan operation in the setting of left juxtaposition of the atrial appendages. The patients were in sinus rhythm at the time of the CMR study. Both patients had episodes of sustained atrial tachyarrhythmia requiring electrical cardioversion and were anticoagulated with warfarin with target INR 2-3. CMR images showed a thrombus located in the enlarged and juxtaposed right appendage in both patients. Blood flow frequently appears slow or sluggish in the dilated right atrium following atriopulmonary Fontan surgery. In addition, cine CMR suggested that blood flow reaches very low velocities in the massively dilated juxtaposed right atrial appendage cul-de-sac, thus potentially creating a substrate for clot formation. These findings propose that juxtaposed atrial appendages in atriopulmonary Fontan is an additional risk factor for clot formation, specifically in the dilated right atrial appendage on the left side juxtaposed with the left atrial appendage and that prophylactic anticoagulation is highly justified in these patients.
Language	English
Publishing date	2016-06-30
Publishing country	Qatar
Document type	Case Reports
ZDB-ID	2738381-7
ISSN	2305-7823
ISSN	2305-7823
DOI	10.21542/gcsp.2016.19
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Article: Apical ballooning with mid-ventricular obstruction: the many faces of Takotsubo cardiomyopathy.

Spadotto, Veronica / Elmaghawry, Mohamed / Zorzi, Alessandro / Migliore, Federico / Marra, Martina Perazzolo

Global cardiology science & practice

2013 Volume 2013, Issue 2, Page(s) 163–168

Abstract: Takotsubo cardiomyopathy (TTC) is a transient left ventricular dysfunction due to akinesia of the left-ventricular (LV) mid-apical segments (apical ballooning), which can cause severe reduction in LV systolic function. The typical clinical picture of TTC ...

Abstract	Takotsubo cardiomyopathy (TTC) is a transient left ventricular dysfunction due to akinesia of the left-ventricular (LV) mid-apical segments (apical ballooning), which can cause severe reduction in LV systolic function. The typical clinical picture of TTC include chest pain, electrocardiographic changes consisting of mild ST-segment elevation followed by diffuse deep T-wave inversion, QTc interval prolongation and mild troponin release in the absence of significant coronary stenoses. The syndrome often affects post-menopausal women and is triggered by sympathetic overstimulation, like intense physical or emotional stress, so that it is called the "broken heart syndrome". Although left-ventricular systolic dysfunction usually fully recovers within few days, heart failure can still complicate the early phase. We report a case of stress-induced cardiomyopathy that had full recovery after 4 weeks of follow up. The main electrocardiographic, angiographic and imaging features are discussed.
Language	English
Publishing date	2013-11-01
Publishing country	Qatar
Document type	Journal Article
ZDB-ID	2738381-7
ISSN	2305-7823
ISSN	2305-7823
DOI	10.5339/gcsp.2013.22
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Article: Heart failure due to 'stress cardiomyopathy': a severe manifestation of the opioid withdrawal syndrome.

Spadotto, Veronica / Zorzi, Alessandro / Elmaghawry, Mohamed / Meggiolaro, Marco / Pittoni, Giovanni Maria

European heart journal. Acute cardiovascular care

2013 Volume 2, Issue 1, Page(s) 84–87

Abstract: Takotsubo cardiomyopathy (TTC) is a transient left ventricular (LV) dysfunction due to akinesia of the LV mid-apical segments ('apical ballooning') in the absence of critical coronary stenoses which can be complicated in the acute phase by heart failure, ...

Abstract	Takotsubo cardiomyopathy (TTC) is a transient left ventricular (LV) dysfunction due to akinesia of the LV mid-apical segments ('apical ballooning') in the absence of critical coronary stenoses which can be complicated in the acute phase by heart failure, mitral regurgitation, life-threatening ventricular arrhythmias, or apical LV thrombosis. The syndrome is typically precipitated by intense emotional or physical stress; however, other causes of sympathetic overstimulation including administration of exogenous sympathomimetics or withdrawal of sympathetic antagonists can trigger TTC. We report the case of a patient who unexpectedly developed an 'apical ballooning' with severe reduction in the LV systolic function and heart failure after the withdrawal of methadone. The case supports the concept that increased sympathetic activity secondary to opioids withdrawal can trigger a stress-induced severe LV dysfunction. Physicians should be aware that the abrupt discontinuation of a long-term therapy with opioids may lead to serious cardiac complications. The administration of clonidine may be considered to prevent early clinical manifestations of addictive withdrawal, including TTC.
Language	English
Publishing date	2013-08-25
Publishing country	England
Document type	Journal Article
ZDB-ID	2663340-1
ISSN	2048-8734 ; 2048-8726
ISSN (online)	2048-8734
ISSN	2048-8726
DOI	10.1177/2048872612474923
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