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Specific Populations: Paediatric and Adolescent Athletes

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Textbook of Sports and Exercise Cardiology

Abstract

The success of systematic early age talent development has led to the professionalisation of youth sports academies used by clubs and governing bodies alike, and sports physicians are nowadays commonly confronted with paediatric cardiological problems. This has led to calls from the International Olympic Committee, amongst others, for more diligence to safeguard the psycho-physiological development of the paediatric athlete. Medical cardiac care of the paediatric athlete however is in its infancy and international guidelines, present for many common adult sports cardiology scenarios, are not available yet. The aim of this chapter is to provide a practical approach to the cardiac care of the paediatric athlete to facilitate healthy and above all, safe talent development, but also provide guidance on how to distinguish adaptive, beneficial cardiovascular remodelling from underlying pathology of congenital or inherited cardiovascular disease, including cardiomyopathies and arrhythmias. Differences in presentation, diagnosis and treatment between childhood and adult athletes are highlighted and can educate the reader in the emerging field of paediatric sports cardiology.

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Author information

Authors and Affiliations

  1. Congenital Heart Unit, Bristol Heart Institute, Bristol, UK

    Guido E. Pieles

  2. Department of Pediatric Cardiology, Heart of the Valley Pediatric Cardiology, Pleasanton, CA, USA

    Andrew Maxwell

  3. Department of Preventative Paediatrics, Faculty of Sports and Health Sciences, Technical University of Munich, Munich, Germany

    Renate Oberhoffer

Authors
  1. Guido E. Pieles
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  2. Andrew Maxwell
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  3. Renate Oberhoffer
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Corresponding author

Correspondence to Guido E. Pieles .

Editor information

Editors and Affiliations

  1. Private Center for Sports and Exercise Cardiology, München, Bayern, Germany

    Axel Pressler

  2. University Institute of Sports Medicine Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria

    Josef Niebauer

Review

Review

1.1 Questions

  1. 1.

    Do paediatric athletes between 12 and 16 years of age show significant training related cardiac adaptations?

  2. 2.

    Can adult cardiac screening and diagnostic criteria and guidelines be applied to paediatric athletes?

  3. 3.

    Do paediatric athletes are at risk of developing the same arrhythmias as adult athletes?

1.2 Answers

  1. 1.

    Recent professionalisation of athletic training in academies has led to training intensity and volumes that can lead to cardiac changes in chamber size and ventricular wall thickness and are also visible in the 12-lead ECG as recently shown in a meta-analysis. As in adults, ethnicity specific changes are detectable, and the sports cardiologist needs to be aware of these [125].

  2. 2.

    No specific cardiac screening guidelines exist, the available recommendations are modelled on adult guidelines [22]. The latest adult athlete ECG screening guidelines (International Criteria) have been evaluated in athletes younger than 16 years of age and found to have moderate accuracy and should be used [31].

  3. 3.

    The incidence and types of arrhythmias in paediatric athletes differ slightly from those found in adult athletes. Accessory pathways such as WPW are most common, congenital heart blocks of varying degrees are more often observed. Importantly, as in adults, cardiac arrest can be the first presentation of a ventricular arrhythmia or a myocardial disease, malignant arrhythmias such as CPVT often present in teenage years, and early diagnosis of ventricular arrhythmias and arrhythmogenic cardiomyopathies remains a particular challenge in paediatric athletes. Atrial fibrillation and flutter are very rare.

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Pieles, G.E., Maxwell, A., Oberhoffer, R. (2020). Specific Populations: Paediatric and Adolescent Athletes. In: Pressler, A., Niebauer, J. (eds) Textbook of Sports and Exercise Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-35374-2_23

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  • DOI: https://doi.org/10.1007/978-3-030-35374-2_23

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