Cardiac arrhythmias in the athlete: the evolving role of electrophysiology

ArticleinCurrent Sports Medicine Reports 1(2):75-85 · May 2002with5 Reads
DOI: 10.1007/s11932-002-0054-2 · Source: PubMed
Abstract
Arrhythmia management has undergone a revolution in the past decade. The diagnosis and treatment of arrhythmias in the athlete can be complicated by the need to compete and exercise. Some arrhythmias may be benign and asymptomatic, but others may be life threatening. Sinus bradyarrhythmias are common and even expected in athletes; these are rarely a cause for concern. Heart block is unusual and merits a thorough work-up. Atrial fibrillation may be more common in the athlete, and supraventricular tachycardias other than atrial fibrillation warrant consideration of radiofrequency ablation for cure. Ventricular arrhythmias in the athlete generally occur in the setting of structural heart disease that is genetically determined (hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, anomalous coronary arteries), or acquired (coronary artery disease, myocarditis, idiopathic dilated cardiomyopathies). In these conditions the arrhythmia is life threatening. Ventricular arrhythmias that occur in the athlete without structural heart disease are not thought to be life threatening. Athletes with structural heart disease and those with exertional syncope merit a complete evaluation.
    • "As expected, a slower resting heart rate is a marked cardiac adaptation to endurance training and athletes may develop 1 st and 2 nd degree AVB [14]. Third degree AVB is unusual in athletes and requires a careful evaluation [15]. However, some athletes may develop transient third-degree heart block during sleep when the vagal tone is high. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Healthy adults who are the least fit have a mortality risk that is 4.5 times. Surprisingly an individual's physical exercise level was one of the most important predictors of death than well-known risk factors such as smoking, hypertension, high cholesterol, and diabetes. Studies underscore the fact that fitness and daily activity levels have a strong influence on the incidence of heart disease and overall mortality. Based on these facts we observed several individuals assess how far physical exercise can be beneficial in the long term.
    Full-text · Article · Aug 2016 · Herz
    • "Moreover,Figure 1 clearly demonstrates the added anti-arrhythmic benefits from substantially exceeding the minimum guideline activity levels currently recommended for health [23,39]. However, these data do not negate the importance of careful monitoring of runners with symptoms or at high risk for arrhythmias [40]. "
    [Show abstract] [Hide abstract] ABSTRACT: Walking is purported to reduce the risk of atrial fibrillation by 48%, whereas jogging is purported to increase its risk by 53%, suggesting a strong anti-arrhythmic benefit of walking over running. The purpose of these analyses is to compare incident self-reported physician-diagnosed cardiac arrhythmia to baseline energy expenditure (metabolic equivalent hours per day, METhr/d) from walking, running and other exercise. Proportional hazards analysis of 14,734 walkers and 32,073 runners. There were 1,060 incident cardiac arrhythmias (412 walkers, 648 runners) during 6.2 years of follow-up. The risk for incident cardiac arrhythmias declined 4.4% per baseline METhr/d walked by the walkers, or running in the runners (P = 0.0001). Specifically, the risk declined 14.2% (hazard ratio: 0.858) for 1.8 to 3.6 METhr/d, 26.5% for 3.6 to 5.4 METhr/d, and 31.7% for ≥5.4 METhr/d, relative to <1.8 METhr/d. The risk reduction per METhr/d was significantly greater for walking than running (P<0.01), but only because walkers were at 34% greater risk than runners who fell below contemporary physical activity guideline recommendations; otherwise the walkers and runners had similar risks for cardiac arrhythmias. Cardiac arrhythmias were unrelated to walking and running intensity, and unrelated to marathon participation and performance. The risk for cardiac arrhythmias was similar in walkers and runners who expended comparable METhr/d during structured exercise. We found no significant risk increase for self-reported cardiac arrhythmias associated with running distance, exercise intensity, or marathon participation. Rhythm abnormalities were based on self-report, precluding definitive categorization of the nature of the rhythm disturbance. However, even if the runners' arrhythmias include sinus bradycardia due to running itself, there was no increase in arrhythmias with greater running distance.
    Full-text · Article · Jun 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Cardiac arrhythmias in athletes are frequent events in medical practice and require a profound diagnostic procedure. It is necessary to differentiate between harmless alterations of cardiac rhythm and potentially dangerous arrhythmias. While the former are mostly the result of an increased vagotone as a consequence of endurance training, the latter are raising the question whether intensive physical and mental strains in competitive exercise are compatible with the cardiac arrhythmias diagnosed. Vagotone-induced alterations of cardiac arrhythmias generally disappear under exercise conditions. It is essential to include the type, intensity and duration of the athletic activities into the differential-diagnostic evaluations. However, those medical considerations frequently collide with economic interests. Sinus bradycardia is a typical example of vagotone-induced arrhythmias, which may be observed especially in highly endurance-trained athletes. Sinus bradycardias are mostly asymptomatic and rarely the cause of grave complications; therapeutic interventions are only required if clinical symptoms such as orthostatic disturbances are present. The different variants of cardiac conduction defects are—within certain limits—also frequently induced by an increased vagotone; generally, they require an intensive cardiologic diagnosis. Another frequent form of arrhythmias are ventricular extrasystoles. Their dignity may be assessed by exercise ECG. Disappearance under exercise conditions is, generally, a positive sign. Diagnosis and therapy of cardiac arrhythmias are based on the established guidelines. Additionally, regular cardiologic screenings are required in high-performance athletes of all age groups.
    Article · Jan 2004
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