Clinical significance of exercise-induced ventricular tachyarrhythmias in trained athletes without cardiovascular abnormalities
Introduction
Frequent and complex ventricular tachyarrhythmias in trained athletes without cardiovascular abnormalities, identified by ambulatory (Holter) monitoring, have been considered a clinically benign expression not infrequently associated with the physiologic athlete’s heart.1, 2, 3, 4, 5 These arrhythmias, when present at rest, usually disappear during exercise as well as after periods of deconditioning,6 do not reappear in a significant degree after resumption of training3 and are unrelated to the magnitude of physiologic left ventricular hypertrophy.2
Notably, however, ventricular arrhythmias occurring during exercise in patients with structural heart disease, including coronary artery disease in older patients7, 8 or arrhythmogenic right ventricular cardiomyopathy (ARVC) and ion channelopathies in young patients,9, 10 have been considered risk markers for sudden cardiac death. At present, the clinical significance of exercise-induced ventricular arrhythmias in trained athletes without apparent cardiovascular disease remains unresolved. Therefore, the objectives of this study were to clarify the clinical significance and consequences of ventricular tachyarrhythmias occurring during exercise in a large population of young athletes without evident cardiovascular abnormalities and to assess their impact on eligibility for participation in competitive sports.
Section snippets
Patient selection
Since 1982, the Italian government has required by law that all citizens participating in officially sanctioned competitive sports undergo preparticipation screening to exclude the presence of cardiovascular diseases that would be associated with an increased risk of sudden death during training and competition.11 At the Institute of Sports Medicine and Science (Rome), all competitive athletes, selected for inclusion in national and Olympic teams, undergo systematic medical evaluation that
Ventricular tachyarrhythmias during exercise stress testing
Of the 5011 athletes without structural heart disease in the study group, 367 (7.3%) showed ≥1 premature ventricular beat (PVB), including 331 (6.6%) with ≤10 PVBs (mean 5.2 ± 4; range 1–9) and 36 (0.7%) with >10 PVBs (range 10–173; mean 45 ± 38), and/or ≥1 ventricular couplets (range 1–58; mean 9 ± 15), and/or ≥1 bursts of nonsustained ventricular tachycardia (NSVT; mean 2 ± 4) of 3–15 beats in length at rates of 145–188 beats/min (Table 1).
In most of the athletes with arrhythmias (251 of 367
Discussion
The significance of ventricular tachyarrhythmias in trained athletes has been an issue of concern to those practitioners dedicated to the care of this population and the cardiology community.14 This sensitivity is largely related to the visibility afforded by sudden death in young competitive athletes over the last 30 years, mainly in those with underlying and usually unsuspected cardiovascular disease.15, 16, 17, 18 However, ventricular arrhythmias are not uncommon in athletes without evidence
Conclusion
In a large consecutive cohort of young highly trained and elite athletes, ventricular tachyarrhythmias induced by exercise testing were found in 7%. However, in only 0.3% of the athletes did these arrhythmias justify consideration for radiofrequency ablation. These arrhythmias, either PVBs and/or complex forms, showed marked spontaneous reduction over time in the vast majority of athletes, and were not associated with cardiovascular morbidity or mortality over the follow-up period, despite
References (36)
- et al.
Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes
J Am Coll Cardiol
(2002) - et al.
Relation between training-induced left ventricular hypertrophy and risk for ventricular tachyarrhythmias in elite athletes
Am J Cardiol
(2008) - et al.
Patterns of ventricular tachyarrhythmias associated with training, deconditioning and retraining in elite athletes without cardiovascular abnormalities
Am J Cardiol
(2011) - 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) - et al.
Impact of physical deconditioning on ventricular tachyarrhythmias in trained athletes
J Am Coll Cardiol
(2004) - et al.
Noninvasive cardiac screening in young athlete with ventricular arrhythmias
Am J Cardiol
(2013) - et al.
Electrocardiographic comparison of ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy and right ventricular outflow tract tachycardia
J Am Coll Cardiol
(2011) Arrhythmias originating from the right ventricular outflow tract: how to distinguish “malignant” from “benign”?
Heart Rhythm
(2009)Ventricular ectopy in athletes: don’t worry… more good news
J Am Coll Cardiol
(2002)- et al.
Introduction: eligibility recommendations for competitive athletes with cardiovascular abnormalities—general considerations
J Am Coll Cardiol
(2005)
Does sports activity enhance the risk of sudden death in adolescents and young adults?
J Am Coll Cardiol
Bethesda Conference #36 and the European Society of Cardiology Consensus Recommendations revisited a comparison of U.S. and European criteria for eligibility and disqualification of competitive athletes with cardiovascular abnormalities
J Am Coll Cardiol
Effects of catheter ablation of “asymptomatic” frequent ventricular premature complexes with reduced (<48%) left ventricular ejection fraction.
Am J Cardiol
Nonsustained ventricular tachycardia
J Am Coll Cardiol
Long-term clinical consequences of intense, uninterrupted endurance training in Olympic athletes
J Am Coll Cardiol
Prevalence and clinical significance of left atrial remodeling in competitive athletes
J Am Coll Cardiol
Clinical and electrophysiological spectrum of idiopathic ventricular outflow tract arrhythmias
J Am Coll Cardiol
Long-term outcome in asymptomatic men with exercise-induced premature ventricular depolarizations
N Engl J Med
Cited by (56)
The Influence of Lifestyle Factors on the Occurrence and Severity of Premature Ventricular Contractions: A Comprehensive Review
2024, Current Problems in CardiologyInterpretation and management of premature ventricular beats in athletes: An expert opinion document of the Italian Society of Sports Cardiology (SICSPORT)
2023, International Journal of CardiologyCardiac screening before returning to elite sport after SARS-CoV-2 infection
2022, Archives of Cardiovascular DiseasesExercise Stress Testing in Athletes
2022, Clinics in Sports MedicineClinical management of young competitive athletes with premature ventricular beats: A prospective cohort study
2021, International Journal of CardiologySpecial Article - Exercise-induced right ventricular injury or arrhythmogenic cardiomyopathy (ACM): The bright side and the dark side of the moon
2020, Progress in Cardiovascular DiseasesCitation Excerpt :Analysis of arrhythmias and eligibility for competitive sport are reported and discussed in the 2015 Task Force Criteria.114,115 Verdile et al.116 reported a reliable prevalence of complex ventricular arrhythmias in 36/500 (0.7%). However, even in this study, it was not known whether arrhythmias were due to RV disease.