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Heart Rhythm. 2015 Jan;12(1):78-85. doi: 10.1016/j.hrthm.2014.09.009. Epub 2014 Sep 16.

Clinical significance of exercise-induced ventricular tachyarrhythmias in trained athletes without cardiovascular abnormalities.

Author information

1
Institute of Sports Medicine and Science, Italian Olympic Committee, Rome, Italy.
2
Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.
3
Institute of Sports Medicine and Science, Italian Olympic Committee, Rome, Italy. Electronic address: a.biffi@libero.it.

Abstract

BACKGROUND:

Exercise-induced ventricular tachyarrhythmias raise clinical concern as a marker of increased risk in the presence of underlying cardiovascular disease.

OBJECTIVE:

The aim of this study was to clarify the clinical significance of exercise-induced ventricular tachyarrhythmias in competitive athletes without evident cardiac abnormalities.

METHODS:

Exercise electrocardiographic testing was performed in 5011 consecutive athletes without heart disease and analyzed for the occurrence of ventricular arrhythmias.

RESULTS:

Of the 5011 athletes, 367 (7.3%) showed ≥1 premature ventricular beat (PVB), including 331 (6.6%) with ≤10 PVBs and 36 (0.7%) with >10 PVBs and/or ≥1 ventricular couplets, and/or ≥1 bursts of nonsustained ventricular tachycardia. The 331 athletes with ≤10 PVBs had no restriction from competitive sports, and repeated exercise testing over 3-12 months showed spontaneous reduction of arrhythmia (from 5.2 ± 4 to 4 ± 6 PVBs; P = .002), including 83 of 331 (23%) with disappearance of PVBs. The remaining 36 athletes were disqualified from sports because of frequent and/or complex arrhythmias; 23 showed reduction of arrhythmia at 3-12 months (from 46 ± 42 to 28 ± 11 PVBs, from 8 ± 10 to 3 ± 3 couplets, and from 3.6 ± 6 to 1 ± 1 nonsustained ventricular tachycardia; P = .05) and were readmitted to competition. The other 13 athletes with persistent arrhythmias were considered for radiofrequency ablation, of whom 6 were successfully treated with abolition of arrhythmias and permitted to return to competitive sports. No events or cardiovascular disease occurred in the 367 athletes over a follow-up period of 7.4 ± 5 years.

CONCLUSION:

Exercise-induced ventricular tachyarrhythmias were present in a sizable minority of highly trained athletes without heart disease. These arrhythmias proved to be benign and not associated with adverse events or later development of cardiovascular disease.

KEYWORDS:

Athletes; Exercise; Exercise stress testing; Sports; Sudden death; Ventricular arrhythmias

PMID:
25239428
DOI:
10.1016/j.hrthm.2014.09.009
[Indexed for MEDLINE]

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