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#35 De: Jorge Sanagua  <jsanagua@satlink.com>
Enviado: Sábado, 29 de Abril de 2000 04:08 p.m.
Asunto: WPW en atletas
Queridos colegas y amigos:
El Dr. Daniel Boccardo nos envia estas interesantes consideraciiones referentes a la consulta del Dr. MIGUEL E. MARIN" <marin@infomed.sld.cu> acerca de la presencia de un sindrome de preexcitacion en atletas. Acudiendo a su finisimo humor cordobes y habiendo olvidado que el Primer Congreso Virtual de Cardiologia (que era trilingue) concluyo hace un mes, Daniel envia su contribucion en ingles, posiblemente para decirnos en forma criptica, que profundicemos nuestro conocimiento en el estudio de la lengua sajona. Dado el interes y la calidad de la respuesta de Boccardo, la envio textual (incluyendo la primer frase en espaniol, para que vean que la conoce); asimismo le pedire que nos envie la version castellana :-)
Dr. Edgardo  Schapachnik
Foro de Educacion Medica Continua en Cardiologia-PCVC - Arritmias
http://pcvc.sminter.com.ar/cvirtual
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Paso a responder la pregunta sobre WPW en atletas:
Dear colleague:
The problem of the finding of a preexitacion syndrome in an athlete is very important and interesting. I believe there is no controversy in the
symptomatic athlete: the definitive treatment is radiofrecuency ablation, specially if the accesory pathway is away from the normal conduction system, that is, the AV node or His bundle. If there is any danger of complicating the procedure with permanent damage to this structures, then a complete discussion of the situation with the young patient and his/her family should be undertaken to weight all the possibilities.The patient may have to give up his/her career as an athlete. On the other hand, if the patient is asymptomatic, that is, never had any palpitation, dizzines,tachycardia, etc. the physician may want to stratify the risk for atrial fibrillation, syncope or sudden death. This could be assessed doing a Holter (intermitent preexitation), stress test (loss of preexitation during effort), injection of ajmaline, procainamide or frecainide IV (disappearance of WPW) and EP study (induction of AF, antegrade effective refractory period of the accesory pathway, rapid  conduction through the accesory pathway). Even if the patient is considered after all this testing low risk for complications, many electrophysiologists would go ahead and perform radiofrecuency ablation of the pathway, since the methods are not fool-proof and the negative predictive value is not 100%. That means, the athlete could still die suddenly while competing, and nobody wants that. My personal opinion:
consider the patient as any other high risk profession: airline pilot, bus driver, police officer, and go ahead an perform readiofrecuency ablation.
Thank you very much for allowing me to opinate about such an interesting topic.
Daniel Boccardo, MD,FACC

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