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Ventricular arrhythmias in the athlete
M S Link1, P J Wang, N A Estes
1The Cardiac Arrhythmia Service, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA. mlink@lifespan.org
Insights
Sudden cardiac death in athletes is often linked to heart disease, but Brugada syndrome and commotio cordis are new causes in healthy hearts. Implantable cardioverter defibrillators offer protection, though their use in athletes requires careful consideration.
Area of Science:
- Cardiology
- Sports Medicine
- Electrophysiology
Background:
- Life-threatening ventricular arrhythmias in athletes typically indicate underlying structural heart disease.
- Recent discoveries include Brugada syndrome and commotio cordis as causes of severe arrhythmias in individuals with structurally normal hearts.
- Non-life-threatening arrhythmias, while often benign, can signal underlying cardiomyopathies.
Purpose of the Study:
- To review the causes and management of life-threatening ventricular arrhythmias in athletes.
- To discuss the role of the implantable cardioverter defibrillator in preventing sudden cardiac death in this population.
- To address the challenges in identifying athletes who would benefit from defibrillator implantation and the implications for athletic participation.
Main Methods:
- Review of current literature on ventricular arrhythmias in athletes.
- Discussion of newly identified causes of arrhythmias, including Brugada syndrome and commotio cordis.
- Analysis of the efficacy and indications for implantable cardioverter defibrillators in athletes.
Main Results:
- Structural heart disease is the primary cause of life-threatening arrhythmias in athletes.
- Brugada syndrome and commotio cordis are emerging causes of severe arrhythmias in athletes with normal hearts.
- Implantable cardioverter defibrillators have significantly improved outcomes, but selection criteria remain challenging.
- Athletes with significant arrhythmias or at-risk structural heart disease are generally advised against competitive sports participation.
Conclusions:
- A comprehensive evaluation is crucial for athletes presenting with syncope, particularly exertional syncope.
- Implantable cardioverter defibrillators provide vital protection against sudden death from ventricular arrhythmias.
- Careful consideration is needed to determine appropriate candidates for defibrillator implantation in athletes.
- Participation in competitive athletics is typically restricted for athletes with known life-threatening arrhythmias or at-risk structural heart disease.
Abstract:
Life-threatening ventricular arrhythmias in the athlete nearly always occur in the presence of structural heart disease. In the last few years, 2 new causes of life-threatening arrhythmias have been described in patients with normal hearts-that of the Brugada syndrome and that of commotio cordis. Non-life-threatening premature ventricular beats and even nonsustained ventricular tachycardia are not rare, and although usually benign, can be secondary to cardiomyopathies. Athletes with symptoms of syncope, especially if exertional, warrant a complete evaluation. The treatment of athletes and other individuals with life-threatening ventricular arrhythmias has been revolutionized by the implantable cardioverter defibrillator, a device that affords excellent protection from sudden death. Defining those athletes who would benefit from the implantable defibrillator is not always clear. Furthermore, participation in competitive athletics for athletes with life-threatening arrhythmias or structural heart disease known to put the athlete at risk for life-threatening arrhythmias is usually prohibited.