Cited by 395Cardiovascular Effects of ExerciseCardiac electrophysiology and arrhythmiasCardiac Arrhythmias and Treatments

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High prevalence of right ventricular involvementin endurance athletes with ventricular arrhythmias Role of an electrophysiologic study in risk stratification

Heidbüchel, H·2003·European Heart Journal

DOI 10.1016/s0195-668x(03)00282-3

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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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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)
DOI: 10.1016/s0195-668x(03)00282-3
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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High prevalence of right ventricular involvementin endurance athletes with ventricular arrhythmias Role of an electrophysiologic study in risk stratification

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