Ionic mechanisms and vectorial model of early repolarization pattern in the surface electrocardiogram of the athlete.

Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
Eduardo C BarbosaPaulo Ginefra

Abstract

The electrocardiogram (ECG) of the athlete displays particular characteristics as a consequence of both electrophysiological and autonomic remodeling of the heart that follows continued physical training. However, doubts persist on how these changes directly interact during ventricular activation and repolarization ultimately affecting surface ECG waveforms in athletes. This article considers an in deep rationale for the electrocardiographic pattern known as early repolarization based on both electrophysiological mechanisms at cellular level and the vectorial theory of the cardiac activation. The mechanism by which the autonomic remodeling influences the cardiac electrical activation is reviewed and an insight model of the ventricular repolarization based on ionic models and the vectorial theory of the cardiac activation is proposed. Considering the underlying processes related to ventricular electrical remodeling, we propose that, in athletes' heart: 1) vagal modulation increases regional electrophysiological differences in action potential phases 1 and 2 amplitudes, thus enhancing a voltage gradient between epicardial and endocardial fibers; 2) this gradient affects depolarization and repolarization timing sequences; 3) repol...Continue Reading

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Citations

May 6, 2011·Circulation. Arrhythmia and Electrophysiology·Peter A NoseworthyAaron L Baggish
May 16, 2015·Trends in Cardiovascular Medicine·Richard Kovacs, Aaron L Baggish
Apr 19, 2011·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Shlomo Stern
Aug 10, 2010·The American Journal of Cardiology·Matthias WilhelmFrank Flachskampf
Jul 1, 2014·The American Journal of Medicine·Ricard Serra-GrimaJuan Cinca
Dec 4, 2014·Journal of Electrocardiology·L HongJ K Kanters
Feb 19, 2016·Circulation. Arrhythmia and Electrophysiology·Philip AagaardDermot Phelan
Feb 7, 2014·Medicine and Science in Sports and Exercise·Philip AagaardLennart Bergfeldt
May 14, 2020·Arquivos brasileiros de cardiologia·Paulo Roberto Benchimol-BarbosaJurandir Nadal
Sep 19, 2020·European Cardiology·Uchenna Ozo, Sanjay Sharma

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