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Cardiac arrhythmias in presidents and other athletes
1Cardiac Rehabilitation and the Internal Medicine Residency Program, Georgia Baptist Medical Center, Atlanta 30312-1239.
Insights
Most rhythm disorders in athletes are benign, like frequent atrial ectopic beats or ventricular premature beats (VPBs). More sustained arrhythmias, such as AVNRT and atrial fibrillation, are manageable with lifestyle changes, medication, or ablation.
Area of Science:
- Cardiology
- Sports Medicine
- Electrophysiology
Background:
- Athletic individuals can experience supraventricular and ventricular rhythm disorders.
- Most rhythm problems in athletes are benign, including frequent atrial ectopic beats and ventricular premature beats (VPBs).
Observation:
- Common sustained supraventricular tachycardias (SVTs) include atrioventricular nodal reentrant tachycardia (AVNRT) and atrial fibrillation.
- Atrial flutter is less common and generally a nuisance, though rare cerebral embolic events can occur.
- Nonsustained ventricular tachycardia (NSVT) and sustained ventricular tachycardia (VT) are infrequently observed in athletes.
Findings:
- Evaluation involves assessing symptomatology, arrhythmia source, underlying cardiac disease, and precipitating factors.
- Therapeutic strategies include avoiding triggers, sequential pharmacotherapy with close monitoring for pro-arrhythmic effects, and electrophysiology-guided treatment for sustained VT.
- Radiofrequency ablation offers a potential alternative to chronic drug therapy for selected cases.
Implications:
- Understanding the benign nature of most arrhythmias in athletes is crucial for appropriate clinical management.
- Distinguishing between benign and potentially life-threatening arrhythmias guides diagnostic and therapeutic decisions.
- Emerging ablation techniques provide less invasive treatment options, potentially improving outcomes for athletes with refractory arrhythmias.
Abstract:
We presented examples of both supraventricular and ventricular rhythm disorders which can occur in athletic individuals, even presidents. The vast majority of rhythm problems we deal with in athletes are fortunately benign, entities such as frequent atrial ectopic beats or VPBs. In each patient encountered, we ask ourselves the five questions noted in the discussion pertaining to symptomatology, anatomic source of the arrhythmia, presence or absence of underlying cardiac disease, and precipitating factors. The most common more sustained SVTs we see are AVNRT and atrial fibrillation. Atrial flutter is less common. These are more of a nuisance to patients rather than a threat to their lives, although rarely cerebral embolic events can occur. Therapy includes avoidance of precipitating factors and, when necessary, a sequential trial of available drugs, carefully documenting the response and watching closely for any pro-arrhythmic events. We infrequently see NSVT in athletes, even triplets of VPBs on exercise testing, and rarely see instances of sustained VT. The latter merits a careful search for underlying cardiac disease and usually electrophysiology-guided drug therapy. New techniques such as radiofrequency ablation of the dysrhythmic focus may obviate the need for chronic drug therapy in selected cases.