Clinical study
Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes

https://doi.org/10.1016/S0735-1097(02)01977-0Get rights and content
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Abstract

Objectives

The aim of this study was to clarify the clinical relevance of ventricular tachyarrhythmias assessed by 24-h ambulatory electrocardiograms (ECG) in a large, unique, and prospectively evaluated athletic population.

Background

For athletes with ventricular tachyarrhythmias, the risk of sudden cardiac death associated with participation in competitive sports is unresolved.

Methods

We assessed 355 competitive athletes with ventricular arrhythmias (VAs) on a 24-h ambulatory (Holter) ECG that was obtained because of either palpitations, the presence of ≥3 premature ventricular depolarizations (PVDs) on resting 12-lead ECG, or both.

Results

Athletes were segregated into three groups: Group A with ≥2,000 PVDs/24 h (n = 71); Group B with ≥100 <2,000 PVDs/24 h (n = 153); and Group C with only <100 PVDs/24 h (n = 131). Cardiac abnormalities were detected in 26 of the 355 study subjects (7%) and were significantly more common in Group A (21/71, 30%) than in Group B (5/153, 3%) or Group C athletes (0/131, 0% p < 0.001). Only the 71 athletes in Group A were excluded from competition. During follow-up (mean, 8 years), 70 of 71 athletes in Group A and each of the 284 athletes in Groups B and C have survived without cardiovascular events. The remaining Group A athlete died suddenly of arrhythmogenic right ventricular cardiomyopathy while participating in a field hockey game against medical advice.

Conclusions

Frequent and complex ventricular tachyarrhythmias are common in trained athletes and are usually unassociated with underlying cardiovascular abnormalities. Such VAs (when unassociated with cardiovascular abnormalities) do not convey adverse clinical significance, appear to be an expression of “athlete’s heart syndrome,” and probably do not per se justify a disqualification from competitive sports.

Abbreviations

ARVC
arrhythmogenic right ventricular cardiomyopathy
ECG
electrocardiogram
EP
electrophysiologic
LBBB
left bundle branch block
MRI
magnetic resonance imaging
NSVT
nonsustained ventricular tachycardia
PVD
premature ventricular depolarization
VA
ventricular arrhythmia
VT
ventricular tachycardia

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Supported in part by a grant from the Paul G. Allen Foundations (Dr. Maron).