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Management of Arrhythmias in Athletes: Atrial Fibrillation, Premature Ventricular Contractions, and Ventricular Tachycardia

  • Sports Cardiology (M Emery, Section Editor)
  • Published:
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Opinion statement

Management of atrial fibrillation, premature ventricular contractions, and ventricular tachycardia without underlying cardiac disease or arrhythmogenic conditions differs in athletes from the general population. Athletes tend to be younger, healthier individuals with few comorbidities. Therapies that work well in the general population may not be appropriate or preferable for athletes. Management strategies include deconditioning, pharmacologic therapy, such as rate control with β-blockers or non-dihydropyridine calcium channel blockers and rhythm control with class I or class III antiarrhythmic drugs, and catheter ablation. Deconditioning is not preferred by athletes because of lost playing time. Pharmacologic therapy is well tolerated among most individuals, but is not as favorable in athletes. Rate control medications can reduce performance and β-blockers, in particular, are prohibited in many sports. Antiarrhythmic drugs are preferred over rate control with athletes, but many, especially younger athletes, may not like the idea of long-term medical therapy. Catheter ablation has been proven to be safe and efficacious, may eliminate the need for long-term medical therapy, and is supported by the major societies (AHA, ACC, ESC).

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Guasch E, Mont L. Diagnosis, pathophysiology, and management of exercise-induced arrhythmias. Nat Rev Cardiol [Internet] Nature Publishing Group. 2016;14:88–101. Available from: http://www.nature.com/doifinder/10.1038/nrcardio.2016.173. Excellent review of pathophysiology, evaluation, and management of exercise-induced arrhythmias.

    Article  Google Scholar 

  2. Walker J, Calkins H, Nazarian S. Evaluation of cardiac arrhythmia among athletes. Am J Med [Internet]. 2010;123:1075–81. Available from: http://www.sciencedirect.com/science/article/pii/S0002934310004559

    Article  Google Scholar 

  3. •• Sharma S, Merghani A, Mont L. Exercise and the heart: the good, the bad, and the ugly. Eur Heart J. 2015;36:1445–53. Excellent review of the effects of exercise on the heart.

    Article  PubMed  Google Scholar 

  4. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):2071–104.

    Article  PubMed  Google Scholar 

  5. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18:1609–78.

    Article  PubMed  Google Scholar 

  6. Zimetbaum P. Atrial fibrillation. Ann Intern Med [Internet]. 2017;166:ITC33. Available from: http://annals.org/article.aspx?doi=10.7326/AITC201703070

    Article  Google Scholar 

  7. Baldesberger S, Bauersfeld U, Candinas R, Seifert B, Zuber M, Ritter M, et al. Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists. Eur Heart J. 2008;29:71–8.

    Article  PubMed  Google Scholar 

  8. Andersen K, Farahmand B, Ahlbom A, Held C, Ljunghall S, Michaëlsson K, et al. Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study. Eur Heart J. 2013;34:3624–31.

    Article  PubMed  Google Scholar 

  9. Turagam MK, Flaker GC, Velagapudi P, Vadali S, Alpert MA. Atrial fibrillation in athletes: pathophysiology, clinical presentation, evaluation and management. J Atr Fibrillation [Internet]. 2016;8:66–72. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=112930379&site=ehost-live

    Google Scholar 

  10. Elliott AD, Mahajan R, Lau DH, Sanders P. Atrial fibrillation in endurance athletes: from mechanism to management. Cardiol Clin [Internet]. Elsevier Inc. 2016;34:567–78. https://doi.org/10.1016/j.ccl.2016.06.006.

    Google Scholar 

  11. Walters TE, Lee G, Spence S, Larobina M, Atkinson V, Antippa P, et al. Acute atrial stretch results in conduction slowing and complex signals at the pulmonary vein to left atrial junction: insights into the mechanism of pulmonary vein arrhythmogenesis. Circ Arrhythmia Electrophysiol. 2014;7:1189–97.

    Article  Google Scholar 

  12. Ueda N, Yamamoto M, Honjo H, Kodama I, Kamiya K. The role of gap junctions in stretch-induced atrial fibrillation. Cardiovasc Res. 2014;104:364–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. •• Zipes DP, Link MS, Ackerman MJ, Kovacs RJ, Myerburg RJ, Estes NAM. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 9: arrhythmias and conduction defects: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66:2412–23. Most recent consensus statement on the evaluation and management of arrhythmias in athletes.

    Article  PubMed  Google Scholar 

  14. Biffi A, Pelliccia A, Verdile L, Fernando F, Spataro A, Caselli S, et al. Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes. J Am Coll Cardiol [Internet] Elsevier Masson SAS. 2002;40:446–52. https://doi.org/10.1016/S0735-1097(02)01977-0.

    Article  Google Scholar 

  15. Delise P, Sitta N, Lanari E, Berton G, Centa M, Allocca G, et al. Long-term effect of continuing sports activity in competitive athletes with frequent ventricular premature complexes and apparently normal heart. Am J Cardiol. 2013;112:1396–402.

    Article  PubMed  Google Scholar 

  16. Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. J Am Coll Cardiol [Internet]. 2006;48:e247–346. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0735109706018171

    Article  Google Scholar 

  17. Biffi A. Idiopathic ventricular arrhythmias in athletes: their causes and when to grant sports eligibility. J Cardiovasc Med (Hagerstown) [Internet]. 2006;7:279–81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16645402

    Article  Google Scholar 

  18. Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J [Internet]. 2015;36:2793–867. Available from: https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehv316

    Article  Google Scholar 

  19. Aliot EM, Stevenson WG, Almendral-Garrote JM, Bogun F, Calkins CH, Delacretaz E, et al. EHRA/HRS expert consensus on catheter ablation of ventricular arrhythmias. Europace. 2009;11:771–817.

    Article  PubMed  Google Scholar 

  20. Michowitz Y, Viskin S, Rosso R. Exercise-induced ventricular tachycardia/ventricular fibrillation in the normal heart: risk stratification and management. Card Electrophysiol Clin [Internet] Elsevier Inc. 2016;8:593–600. https://doi.org/10.1016/j.ccep.2016.04.008.

    Article  Google Scholar 

  21. Biffi A. How to manage athletes with ventricular arrhythmias. Cardiol Clin. 2007;25:449–55.

    Article  PubMed  Google Scholar 

  22. Link MS, Mark Estes NA. Athletes and arrhythmias. J Cardiovasc Electrophysiol. 2010;21:1184–9.

    Article  PubMed  Google Scholar 

  23. Katritsis DG, Zareba W, Camm AJ. Nonsustained ventricular tachycardia. J Am Coll Cardiol [Internet] Elsevier Inc. 2012;60:1993–2004. https://doi.org/10.1016/j.jacc.2011.12.063.

    Article  Google Scholar 

  24. Heidbuchel H, Prior DL, La Gerche A. Ventricular arrhythmias associated with long-term endurance sports: what is the evidence? Br J Sports Med [Internet]. 2012;46:i44–50. Available from: http://bjsm.bmj.com/lookup/doi/10.1136/bjsports-2012-091162

    Article  Google Scholar 

  25. James CA, Bhonsale A, Tichnell C, Murray B, Russell SD, Tandri H, et al. Exercise increases age-related penetrance and arrhythmic risk in arrhythmogenic right ventricular dysplasia/cardiomyopathy-associated desmosomal mutation carriers. J Am Coll Cardiol. 2013;62:1290–7.

    Article  PubMed  Google Scholar 

  26. Pitzalis MV, Mastropasqua F, Massari F, Passantino A, Forleo C, Luzzi G, et al. Dependency of premature ventricular contractions on heart rate. Am Heart J. 1997;133:153–61.

    Article  CAS  PubMed  Google Scholar 

  27. Biffi A, Maron BJ, Culasso F, Verdile L, Fernando F, Di Giacinto B, et al. Patterns of ventricular tachyarrhythmias associated with training, deconditioning and retraining in elite athletes without cardiovascular abnormalities. Am J Cardiol [Internet] Elsevier Inc. 2011;107:697–703. https://doi.org/10.1016/j.amjcard.2010.10.049.

    Article  Google Scholar 

  28. Latchamsetty R, Bogun F. Premature ventricular complex-induced cardiomyopathy. Rev Española Cardiol. 2016;69:365–9.

    Article  Google Scholar 

  29. Aizer A, Gaziano JM, Cook NR, Manson JE, Buring JE, Albert CM. Relation of vigorous exercise to risk of atrial fibrillation. Am J Cardiol [Internet]. Elsevier Inc. 2009;103:1572–7. https://doi.org/10.1016/j.amjcard.2009.01.374.

    Article  Google Scholar 

  30. Drca N, Wolk A, Jensen-Urstad M, Larsson SC. Atrial fibrillation is associated with different levels of physical activity levels at different ages in men. Heart [Internet]. 2014;100:1037–42. Available from: http://heart.bmj.com/lookup/doi/10.1136/heartjnl-2013-305304

    Article  Google Scholar 

  31. Thelle DS, Selmer R, Gjesdal K, Sakshaug S, Jugessur A, Graff-Iversen S, et al. Resting heart rate and physical activity as risk factors for lone atrial fibrillation: a prospective study of 309 540 men and women. Heart [Internet]. 2013;99:1755–60. Available from: http://heart.bmj.com/lookup/doi/10.1136/heartjnl-2013-303825

    Article  Google Scholar 

  32. Bapat A, Zhang Y, Post WS, Guallar E, Soliman EZ, Heckbert SR, et al. Relation of physical activity and incident atrial fibrillation (from the multi-ethnic study of atherosclerosis). Am J Cardiol [Internet]. Elsevier Inc. 2015;116:883–8. https://doi.org/10.1016/j.amjcard.2015.06.013.

    Article  Google Scholar 

  33. Pelliccia A, Fagard R, Bjørnstad HH, Anastassakis A, Arbustini E, Assanelli D, et al. Recommendations for competitive sports participation in athletes with cardiovascular disease. Med dello Sport. 2005;58:157–91.

    Google Scholar 

  34. Oral H, Pappone C, Chugh A, Good E, Bogun F, Pelosi F, et al. Circumferential pulmonary-vein ablation for chronic atrial fibrillation. N Engl J Med [Internet]. 2006;354:934–41. Available from: http://www.nejm.org/doi/abs/10.1056/NEJMoa050955

    Article  CAS  Google Scholar 

  35. Latchamsetty R, Morady F. Catheter ablation of atrial fibrillation. Heart fail Clin [Internet]. Elsevier Inc. 2016;12:223–33. https://doi.org/10.1016/j.hfc.2015.08.018.

    Article  Google Scholar 

  36. Sorgente A, Chierchia GB, De Asmundis C, Sarkozy A, Capulzini L, Brugada P. Complications of atrial fibrillation ablation: when prevention is better than cure. Europace. 2011;13:1526–32.

    Article  PubMed  Google Scholar 

  37. Calvo N, Mont L, Tamborero D, Berruezo A, Viola G, Guasch E, et al. Efficacy of circumferential pulmonary vein ablation of atrial fibrillation in endurance athletes. Europace. 2010;12:30–6.

    Article  PubMed  Google Scholar 

  38. Koopman P, Nuyens D, Garweg C, La Gerche A, De Buck S, Van Casteren L, et al. Efficacy of radiofrequency catheter ablation in athletes with atrial fibrillation. Europace. 2011;13:1386–93.

    Article  PubMed  Google Scholar 

  39. Furlanello F, Lupo P, Pittalis M, Foresti S, Vitali-Serdoz L, Francia P, et al. Radiofrequency catheter ablation of atrial fibrillation in athletes referred for disabling symptoms preventing usual training schedule and sport competition. J Cardiovasc Electrophysiol. 2008;19:457–62.

    Article  PubMed  Google Scholar 

  40. Gallagher C, Hendriks JML, Mahajan R, Middeldorp ME, Elliott AD, Pathak RK, et al. Lifestyle management to prevent and treat atrial fibrillation. Expert Rev Cardiovasc Ther [Internet] Taylor & Francis. 2016;14:799–809. Available from: http://www.tandfonline.com/doi/full/10.1080/14779072.2016.1179581

    Article  CAS  Google Scholar 

  41. Biffi A, Maron BJ, Verdile L, Fernando F, Spataro A, Marcello G, et al. Impact of physical deconditioning on ventricular tachyarrhythmias in trained athletes. J Am Coll Cardiol [Internet]. Elsevier Masson SAS. 2004;44:1053–8. https://doi.org/10.1016/j.jacc.2004.05.065.

    Article  Google Scholar 

  42. Delise P, Lanari E, Sitta N, Centa M, Allocca G, Biffi A. Influence of training on the number and complexity of frequent VPBs in healthy athletes. J Cardiovasc Med (Hagerstown). 2011;12:157–61.

    Article  Google Scholar 

  43. John RM, Stevenson WG. Outflow tract premature ventricular contractions and ventricular tachycardia: the typical and the challenging. Card Electrophysiol Clin [Internet]. Elsevier Inc. 2016;8:545–54. https://doi.org/10.1016/j.ccep.2016.04.004.

    Article  Google Scholar 

  44. Saeid AK, Klein GJ, Leong-Sit P. Sustained ventricular tachycardia in apparently normal hearts. Card Electrophysiol Clin [Internet]. Elsevier Inc. 2016;8:631–9. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1877918216300685

    Article  Google Scholar 

  45. Ling Z, Liu Z, Su L, Zipunnikov V, Wu J, Du H, et al. Radiofrequency ablation versus antiarrhythmic medication for treatment of ventricular premature beats from the right ventricular outflow tract prospective randomized study. Circ Arrhythmia Electrophysiol. 2014;7:237–43.

    Article  CAS  Google Scholar 

  46. Rorvik SD, Chen J, Hoff PI, Solheim E, Schuster P. 10-year follow-up after radiofrequency ablation of idiopathic ventricular arrhythmias from right ventricular outflow tract. Indian Pacing Electrophysiol J [Internet] Elsevier Ltd. 2016;16:88–91. https://doi.org/10.1016/j.ipej.2016.08.005.

    Article  Google Scholar 

  47. Latchamsetty R, Yokokawa M, Morady F, Kim HM, Mathew S, Tilz R, et al. Multicenter outcomes for catheter ablation of idiopathic premature ventricular complexes. JACC Clin Electrophysiol. 2015;1:116–23.

    Article  Google Scholar 

  48. Fichtner S, Senges J, Hochadel M, Tilz R, Willems S, Eckardt L, et al. Safety and efficacy in ablation of premature ventricular contraction: data from the German ablation registry. Clin Res Cardiol. 2017;106:49–57.

    Article  CAS  PubMed  Google Scholar 

  49. Katz DF, Turakhia MP, Sauer WH, Tzou WS, Heath RR, Zipse MM, et al. Safety of ventricular tachycardia ablation in clinical practice. Circ Arrhythmia Electrophysiol. 2015;8:362–70.

    Article  Google Scholar 

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Authors and Affiliations

  1. School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Ernest Lai BS

  2. Sports Cardiology Clinic, Frankel Cardiovascular Center, University of Michigan Medical School, Michigan Medicine, 1500 E Medical Center Dr SPC 5856, Ann Arbor, MI, 48109-5856, USA

    Eugene H. Chung MD, FACC, FAHA, FHRS

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Lai, E., Chung, E.H. Management of Arrhythmias in Athletes: Atrial Fibrillation, Premature Ventricular Contractions, and Ventricular Tachycardia. Curr Treat Options Cardio Med 19, 86 (2017). https://doi.org/10.1007/s11936-017-0583-x

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