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Common cardiac issues in athletes

Session presentations
  • Interpretation and consequences of repolarisation anomalies. Presented by Sanjay SHARMA (London, GB) See the slides
  • How to perform echocardiographic assessment. Presented by Andre LA GERCHE (Leuven, BE) See the slides
  • How to manage a veteran athlete with atrial fibrillation. Presented by Lluis MONT (Barcelona, ES) See the slides
  • How to manage athletes with minor congenital abnormalities. Presented by Jolien W ROOS-HESSELINK (Rotterdam, NL) See the slides

Intense and prolonged physical training can induce cardiac adaptations called “Athlete’s heart”. In some cases their benignity can be discussed.  Concerning the ECG changes most of the questions concern repolarisation anomalies (RA) observed in more than 60% of athletes. Prof. Sharma (London, UK) described these RA and concluded that they do not have the same signification. Tall T waves (TW), typical early repolarisation (ERP), negative TW from V1-V4 before 16 years are surely benign. The specific pattern of ERP with an up elevation and domed ST segment followed by a negative TW from V1 to V4 seems also benign in black athletes because of its high prevalence (20-25%). A cardiologist’s advice is needed in case of ERP with J elevation >0.2 mv and horizontal ST-segment in inferior leads, types 2 and 3 Brugada patterns, QTc duration between 460-490 and negative TW in infero-lateral leads in black athletes. Lastly a full cardiovascular exam is required in case of ST segment depression, negative TW after V2 in Caucasian adult athletes, short QTc duration, QTc > 500, Brugada type 1.

Concerning echocardiography, Dr Lagerche (Leuven, Belgium and Melbourne, Australia) reminded the audience that this exam must be always evaluated with clinical and ECG data. TM data like classical 2D analysis have currently a great value and the TDI and strain rate can help in difficult cases. Athlete’s heart is mainly dilated in the four cavities with a mild hypertrophy of the left ventricular wall. Systolic function can be at the lower limit. The LV/RV, LV/LA and LV volume/mass ratios are always maintained and all adaptations must be correlated to the performance level in an asymptomatic athlete.

In the master endurance athlete, Dr Mont (Barcelona, Spain) reported that atrial fibrillation (AF) prevalence is higher than in the general population. This is due to the autonomic nervous system adaptations and to the electrophysiological and morphological remodeling of atria. In case of lone paroxystic AF, a decrease in training level must be advised. Ablation can be proposed with the same efficacy as in the standard population, but it must not be proposed in order to permit the athlete to maintain same level of training and competition, because of the high risk of AF recurrence. In case of permanent AF, clearance for sport participation can be given if the ventricular rate during exercise is well controlled and if needed with beta-blockers.

Dr Roos-Hesselink (Rotterdam, Netherlands) reminded the audience that physical activity is healthy for all people but that in case of congenital abnormalities, clearance to participate in sport has several medical pre-requisites. The patient must be asymptomatic with a normal physical capacity evaluated with a CPX test, without right or left ventricular dysfunction, dilated aorta, resting or exercise pulmonary hypertension, and significant arrhythmias and especially adrenergic arrhythmias.




Common cardiac issues in athletes

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.