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Specific Cardiovascular Diseases and Competitive Sports Participation: Arrhythmias

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Textbook of Sports and Exercise Cardiology

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Abstract

Because of the neuro-autonomic remodeling with increased vagal tone, trained athletes commonly develop benign rhythm and conduction disturbances including sinus bradycardia, junctional rhythm, first-degree and second-degree Mobitz type-I atrioventricular block, that disappear with adrenergic stimulation during exercise and do not preclude sports participation. Paroxysmal supraventricular tachycardia and atrial fibrillation usually occur in athletes with a structurally normal heart but may be incompatible with competitive sports activity in case of severe symptoms or exercise-dependent episodes. On the other hand, ventricular arrhythmias ranging from isolated premature ventricular beats to ventricular tachycardia require careful clinical investigation aiming to exclude an underlying structural heart disease potentially at risk of sudden cardiac death before the athlete can safely engage in high-intensity exercise.

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Author information

Authors and Affiliations

  1. Institute of Sports Medicine & Science, Italian Olympic Committee, Rome, Italy

    Alessandro Biffi

  2. Department of Cardiac, Thoracic, Vascular and Public Health Sciences, University of Padova, Padova, Italy

    Alessandro Zorzi & Domenico Corrado

Authors
  1. Alessandro Biffi
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  2. Alessandro Zorzi
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  3. Domenico Corrado
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Corresponding author

Correspondence to Domenico Corrado .

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.

    Top-level athlete, male, 28 years old, practicing soccer from 15 years, asymptomatic, without family and personal history for cardiovascular disease, presenting with a second-degree, type 1 atrio-ventricular block during resting 12-lead ECG. What examination may be useful to guarantee his sport eligibility?

  2. 2.

    Volleyball player, male, 27 years old, without clinical history of sudden death, asymptomatic, during pre-participation screening; occurrence of exercise-induced ventricular arrhythmias during an exercise stress test, sometimes as couplets, with RBBB morphology and wide QRS complex. What further examinations do you suggest?

  3. 3.

    24 years old, male tennis player , presenting with paroxysmal palpitations and resting ECG showing a supraventricular tachycardia at HR 220 bpm, with narrow and regular QRS. The tachycardia has a spontaneous interruption after 10 min. When sinus rhythm is restored, ECG shows the presence of an overt ventricular pre-excitation. Can the athlete be considered eligible for competitive sports activity at this point?

1.2 Answers

  1. 1.

    Exercise stress testing (EST) is the first exam to confirm the physiological, adaptive response of atrio-ventricular node to exercise training. EST usually normalizes the atrio-ventricular conduction during exercise and recovery phase. Also 24-h Holter ECG monitoring, including a training session, could be useful to verify the normalization of AV conduction during an exercise session and to show the maximal expression of AV disturbances during night sleeping.

  2. 2.

    The arrhythmia morphology (RBBB with wide QRS) is uncommon and could be associated with a concealed arrhythmogenic substrate, such as left ventricular scar. Therefore, beyond carrying out colour-doppler echocardiogram and 24-h Holter ECG monitoring, also contrast enhanced cardiac magnetic resonance, with tissue imaging typing, is requested.

  3. 3.

    No. Symptomatic WPW syndrome is not compatible with competitive sports activity. The athlete can be considered suitable for RF catheter ablation.

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Biffi, A., Zorzi, A., Corrado, D. (2020). Specific Cardiovascular Diseases and Competitive Sports Participation: Arrhythmias. In: Pressler, A., Niebauer, J. (eds) Textbook of Sports and Exercise Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-35374-2_17

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  • DOI: https://doi.org/10.1007/978-3-030-35374-2_17

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