The assessment and management of arrhythmias and syncope in the athlete

In recent years the media have reported on the unexpected deaths of prominent athletes and highlighted the sudden cardiac death syndrome. In some cases, there may have been no preceding symptoms to alert coaches or physicians of the impending event. Although sudden cardiac death is rare, there are a number of clinical syndromes that can be diagnosed by careful screening of asymptomatic or minimally symptomatic athletes. In many of these conditions, appropriate intervention can substantially reduce the risk of death. Cardiac arrhythmia and syncope are particularly important symptoms in athletes and may be the initial manifestations of a potentially lethal condition. In this article we pay specific attention to assessing the cardiac risk of athletes presenting with these symptoms.