High prevalence of right ventricular involvementin endurance athletes with ventricular arrhythmias Role of an electrophysiologic study in risk stratification
Abstract
BACKGROUND: Electrocardiographic abnormalities and premature ventricular contractions are common in athletes and are generally benign. However, the specific outcome of high-level endurance athletes with frequent and complex ventricular arrhythmias is unclear. Also, information on the predictive accuracy of different investigations in this subgroup is unknown. RESULTS: We report on 46 high-level endurance athletes with ventricular arrhythmias (45 male; median age 31 years) followed-up for a median of 4.7 years. Eighty percent were cyclists. Hypertrophic cardiomyopathy or coronary abnormalities were present in < or =5%. Eighty percent of the arrhythmias had a left bundle branch morphology. Right ventricular (RV) arrhythmogenic involvement (based on a combination of multiple criteria) was manifest in 59% of the athletes, and suggestive in another 30%. Eighteen athletes developed a major arrhythmic event (sudden death in nine, all cyclists). They were significantly younger than those without event (median 23 years vs 38 years; P=0.01). Outcome could not be predicted by presenting symptoms, non-invasive arrhythmia evaluation or morphological findings at baseline. Only the induction of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) during invasive electrophysiological testing was significantly related to outcome (RR 3.4; P=0.02). Focal arrhythmias were associated with a better prognosis than those due to reentry (P=0.02) but the mechanism could be determined in only 22 (48%). CONCLUSIONS: Complex ventricular arrhythmias do not necessarily represent a benign finding in endurance athletes. An electrophysiological study is indicated for risk evaluation, both by defining inducibility and identifying the arrhythmogenic mechanism. Endurance athletes with arrhythmias have a high prevalence of right ventricular structural and/or arrhythmic involvement. Endurance sports seems to be related to the development and/or progression of the underlying arrhythmogenic substrate.
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For patients with arrhythmogenic right ventricular dysplasia, some early data suggest that exercise may exacerbate the underlying structural abnormalities.
“For patients with arrhythmogenic right ventricular dysplasia, some early data suggests that exercise may exacerbate the underlying structural abnormalities.107,107a”
From Managing with pacemakers and implantable cardioverter defibrillators (2013) · cites this paper as [107]
In “Endurance sports and arrhythmogenic structural RV damage” (page not provided), the authors speculate that endurance sports may contribute to RV structural damage. But they distinguish that possibility from pre-existing ARVD, for which they say exercise may trigger arrhythmias; they do not establish that exercise exacerbates existing structural abnormalities in patients with ARVD. (LLM, conf=0.84)
Experimental — accuracy not yet measuredRecent data suggest that exercise-induced proarrhythmic substrates may develop in the RV while sparing the LV.
“Studies focussing on the LV of athletes have failed to provide these mechanistic insights, 4 but recent data have suggested that exercise-induced proarrhythmic substrates may develop in the RV while sparing the LV.12,13,15”
From Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes (2012) · cites this paper as [13]
Exercise increases potassium, decreases pH, increases catecholamines, and can induce ischemia, any of which could potentially increase the defibrillation threshold.
“Exercise increases potassium, 98 decreases pH, 99 increases catecholamines, 100 and can induce ischemia, any of which could potentially increase the defibrillation threshold.95,[101][102][103]”
From Managing with pacemakers and implantable cardioverter defibrillators (2013) · cites this paper as [100]
The Evaluation and Treatment and outcome sections discuss exercise testing, adrenergic tone, and ICD shocks, but do not address defibrillation thresholds. Searches for defibrillation threshold, potassium, pH, catecholamines, and ischemia found no passage linking exercise-related changes to a higher threshold. (LLM, conf=0.72)
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- Authors
- Heidbüchel, H.
- Affiliations
- Universitair Ziekenhuis Leuven (BE)
- Corresponding author
- Heidbüchel, H
- ORCID
- Heidbüchel, H
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2003-08
- Volume
- 24
- Issue
- 16
- Pages
- 1473-1480
- ISSN
- 0195-668X (ISSN-L)
- OpenAlex
- W2113881585
- Cited by
- 395
- References
- 34
- Citations by year
- 2026: 13 · 2025: 11 · 2024: 12 · 2023: 3 · 2022: 18 · 2021: 16 · 2020: 26 · 2019: 18 · 2018: 24 · 2017: 28 · 2016: 23 · 2015: 32 · 2014: 27 · 2013: 26 · 2012: 27
- FWCI
- 3.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Vlaamse regering
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- endurance athletes, right ventricular involvement, ventricular arrhythmias, sudden cardiac death, risk stratification, electrophysiological study, sustained ventricular tachycardia, ventricular fibrillation, arrhythmogenic substrate, premature ventricular contractions, cyclists, arrhythmia mechanisms
- MeSH terms
- Adolescent, Adult, Arrhythmias, Cardiac, Bicycling, Electrophysiology, Exercise Test, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Sports, Electrocardiography, Ambulatory, Survival Analysis, Tachycardia, Ventricular, Ventricular Dysfunction, Right, Risk Assessment
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