Sudden death in athletes is quite rare; however, in all cases it represents a surprise and a dramatic event for the general population. It is well known that intense physical exercise favours arrhythmias in case of a substrate. Sports-linked acute cardiovascular events are due to the association of physical exercise and presence of an arrhythmogenic substrate like hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, cardiac ischemia….
The possibility that long lasting training can favour the development of an arrhythmogenic substrate is currently the subject of much debate. In other words, sudden cardiac death in athletes is mainly due to an unknown cardiac disease. Unexplained syncope in athletes reauires cardiovascular screening including medical history, physical examination, resting and exercise ECG, echocardiography, Holter, tilt test and if needed electrophysiological study. Ventricular arrhythmia, which is not a classical pattern of athlete’s heart, also needs complete cardiovascular exploration. In few cases of “normal” heart, it seems that high levels of training can favour ventricular arrhythmias, which should disappear after 2-4 months of total detraining. Wolff-Parkinson-White syndrome in athletes, asymptomatic or not, always reauires cardiovascular screening. Ablation is currently recommended in high risk patients. Athlete can compete again 3 months after successful ablation. Today, hypertrophic cardiomyopathy, even treated, is a contraindication to intensive sports practice, both in competition and in leisure time. Lastly, patients with implantable cardioverter-defibrilator cannot participate in high-intensity sports.
Because of the high risk of ventricular arrhythmias during physical exercise, it is important to do as much as possible to detect unknown cardiac disease through adapted cardiovascular pre-participation screening for competitive sports. The ESC Sports Cardiology group recommend at least a medical history, physical examination and 12 lead ECG. In case of cardiac disease, European and American recommendations are available concerning participation in competitive and leisure-time sports.
How to manage athletes with arrhythmias or related symptoms Clinical Seminar
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