[Palpitations in competitive athletes. Risks from premature beats, nonsustained tachycardia and preexcitation]

Cardiovascular screening tests to prevent sudden cardiac death in athletes are discussed controversially, but they should include diligent patient history and physical examination as well as registration of an ECG. If palpitations or tachycardias are described or if preexcitation, supraventricular or ventricular arrhythmias are documented, further risk stratification is mandatory. Specifically the origin and the complexity of the arrhythmia need to be analyzed and any form of structural cardiac pathologies has to be ruled out. Sinus tachycardia, supraventricular and ventricular premature beats, atrial fibrillation as well as supraventricular and ventricular tachycardia may serve as substrate for palpitations. Each of these arrhythmias is associated with a different amount of cardiac risk and can be evidence for certain forms of structural cardiac disease. Recommendations to limit physical activity and specific treatment options depend on the type of the arrhythmia and the presence and the nature of underlying cardiac disease.