Mark S. Link, M.D.; N. A. Mark Estes, M.D.

Disclosures

J Cardiovasc Electrophysiol. 2010;21(10):1184-1189. 

In This Article

Abstract and Introduction

Abstract

Athletes and Arrhythmias.
Athletes are thought the healthiest segment of the population. Yet, there is a general appearance that athletes are more prone to sudden cardiac death and arrhythmias than nonathletes. Bradycardias in athletes are nearly universal, but advanced heart block is usually pathologic. Athletes may be more prone to atrial fibrillation, but not likely to other types of supraventricular tachycardias. Sudden cardiac death in athletes is rare in the absence of heart disease, with the exception of commotio cordis. Treatment strategies for athletes are focused for the return to athletics. Guidelines for treatment will be derived from the 36th Bethesda Guidelines for athletes, and the European Society of Cardiology (ESC) guidelines for athletes.

Introduction

Athletes are thought the healthiest segment of the population. There is a general appearance that athletes are more prone to sudden cardiac death (SCD) and arrhythmias than nonathletes. However, it is not entirely clear whether this is true difference in incidence or merely a reporting bias. The evidence supporting a higher incidence of SCD in athletes is from the Veneto region of Italy. In this retrospective analysis of sudden deaths in the young, athletes had a 2.8-fold increased risk of SCD.[1] However, these data have not been replicated elsewhere, and there is a wealth of epidemiological data that more athletically active individuals have a lower lifetime risk of myocardial infarction (MI) and SCD.

In this article, we will review arrhythmias in athletes and also focus on SCD in athletes. The first section will discuss arrhythmias in athletes with structurally normal hearts, including bradycardias, supraventricular arrhythmias, and ventricular arrhythmias. In the second half, SCD in athletes will be covered. Guidelines for treatment will be derived from the 36th Bethesda Guidelines for athletes,[2] and the European Society of Cardiology (ESC) guidelines for athletes.[3] Competitive sports are generally regarded as those sports in which a premium is placed on winning and to which end athletes are driven to push themselves to exhaustion during sport and training.[4] It is acknowledged that some individuals who do not compete will still reach this definition of competitive sport. There is a general understanding that low-physical intensity competitive sports such as golf and bowling are not prohibited by the Bethesda or ESC guidelines.

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