Altered myocardial electrophysiology after prolonged illicit anabolic androgenic steroid use

Aim

To examine myocardial electrical stability using signal averaging electrocardiography (SAECG) to asses the presence of late ventricular potentials (LPS) in long term anabolic androgenic steroid (AAS) users, and to compare these findings with an age matched control group.

Method

LPS are measured, using surface electrodes, as high frequency signals and are located at the terminal portion of the QRS complex. Such areas of slow inhomogeneous conduction are thought to decrease myocardial electrical stability and provide a re-entry mechanism for malignant ventricular tachycardias.1 After ethical approval from Bro Taf health authority, written informed consent and family medical history was gained from 20 subjects. The subjects were split into two groups: (a) long term (22 (3) years; range 18–30) steroid users (n = 10), which included three previous international competitors and two current competitors, including one national champion and one senior national champion; (b) sedentary controls (n = 10). Subjects were matched for age and VO2max. No subjects reported any history of syncope, cardiovascular disease, or bouts of tachyarrhythmias. Both groups underwent SAECG analysis at rest and after an acute bout of exercise to volitional exhaustion. LPS were analysed using a 40 Hz filter and averaged over 200 beats. Differences between groups were assessed by two way analysis of variance. Incidence was calculated as a percentage of the sample with abnormal SAECGs as previously defined.1

Results

At rest and after an acute bout of exercise, there was no difference in the mean values for any of the LP criteria. However, there was a higher incidence of abnormal LPS in AAS users than in controls, both at rest (30% v 10%) and after an acute bout of exercise (20% v 0%). The incidence of abnormal SAECG in the control group is in agreement with the previous literature.2

Conclusion

Long term AAS use may cause increased electrophysiological instability in certain people, both at rest and after exercise. This may place AAS users at an increased risk of malignant tachyarrhythmias. Although it is an intriguing possibility that, in some people, long term AAS use may push physiological adaptation to a more pathological process, it is speculative at this stage because of the lack of echocardiographic evaluation. However, further study is justified.