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Cardiovascular remodelling in the conditioned athlete is frequently associated with physiological ECG changes. Abnormalities, however, may be detected which represent expression of an underlying heart disease that puts the athlete at risk of arrhythmic cardiac arrest during sports. It is mandatory that ECG changes resulting from intensive physical training are distinguished from abnormalities which reflect a potential cardiac pathology. The present article represents the consensus statement of an international panel of cardiologists and sports medical physicians with expertise in the fields of electrocardiography, imaging, inherited cardiovascular disease, cardiovascular pathology, and management of young competitive athletes. The document provides cardiologists and sports medical physicians with a modern approach to correct interpretation of 12-lead ECG in the athlete and emerging understanding of incomplete penetrance of inherited cardiovascular disease. When the ECG of an athlete is examined, the main objective is to distinguish between physiological patterns that should cause no alarm and those that require action and/or additional testing to exclude (or confirm) the suspicion of an underlying cardiovascular condition carrying the risk of sudden death during sports. The aim of the present position paper is to provide a framework for this distinction. For every ECG abnormality, the document focuses on the ensuing clinical work-up required for differential diagnosis and clinical assessment. When appropriate the referral options for risk stratification and cardiovascular management of the athlete are briefly addressed.

The reproducibility of electrocardiographic (ECG) recordings in syncopal recurrences and the diagnostic role of nonsyncopal arrhythmias are not well known. The objective of this study was to analyse the reproducibility of the ECG findings recorded with implantable loop recorders in 41 patients with suspected neurally-mediated syncope who were included in the International Study on Syncope of Uncertain Origin-2 study and that had > or =2 events recorded by implantable loop recorders. In these patients, the electrocardiogram obtained with the first documented syncope (index syncope) was compared with other recorded events. Twenty-two patients had > or =2 syncopes, and their electrocardiograms were reproducible in 21 (95%): 15 with sinus rhythm, 5 with asystole, and 1 with ventricular tachycardia; 1 had asystole at first syncope and sinus rhythm at recurrent syncope. In 32 patients with nonsyncopal episodes, an arrhythmia was documented in 9, and all of them had the same arrhythmia during the index syncope (100% reproducibility); conversely, when sinus rhythm was documented (23 patients) during nonsyncopal episodes, an arrhythmia was still documented in 6 during the index syncope (70% reproducibility; p = 0.0004). In conclusion, the ECG findings during the first syncope are highly reproducible in subsequent syncopes. The presence of an arrhythmia during nonsyncopal episodes is also highly predictive of the mechanism of syncope, but the presence of sinus rhythm does not rule out the possibility of arrhythmia during syncope. Therefore the finding of an arrhythmia during a nonsyncopal episode allows the etiologic diagnosis of syncope, and eventually to anticipate treatment, without waiting for syncope

In the paper, a novel technique for the direct torque control (DTC) of an induction motor is proposed, which overcomes the trouble of high torque ripple afflicting the conventional DTC technique. With the novel technique, the inverter voltage vector selected from the switching table is applied for the time interval needed by the torque to reach the upper (or the lower) limit of the band, where the time interval is calculated from a suitable modeling of the torque dynamics. By this approach, the control system emulates the operation of a torque hysteresis controller of analog type since the application time of the inverter voltage vector is dictated by the allowed torque excursion and not by the sampling period. It is shown by experimental results that the technique yields a considerable reduction of the torque ripple. A further and ultimate reduction is obtained by compensating for the delay inherent in the discrete-time operation of the control system. The outcome is that the torque ripple of the motor is constrained within the hysteresis band of the torque controller, for a band of customary value. An ancillary merit of the technique is the almost full elimination of the average torque error inherent in the conventional technique. If the hysteresis band is shrunk, the torque ripple is bound to swing out the band limits. Under this circumstance, an extension of the technique is developed, which helps keep the torque ripple at minimum. To assess the characteristics of the proposed DTC technique, the following quantities: average torque error, rms value of the torque ripple, and inverter switching frequency are measured for different stator flux angular speeds and hysteresis bands of the torque and flux controllers. As a comparison, the same quantities are given for the conventional DTC technique.