Advertisement

Push harder to allow pushing harder

  • Hein Heidbuchel
    Correspondence
    Address reprint requests and correspondence: Dr Hein Heidbuchel, Department of Cardiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Antwerp, Belgium.
    Affiliations
    Cardiovascular Research, Antwerp University, Antwerp, Belgium
    Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
    Hasselt University, Hasselt, Belgium
    Search for articles by this author
Published:September 23, 2021DOI:https://doi.org/10.1016/j.hrthm.2021.09.023
      International sports eligibility recommendations, both in Europe and in North America, state that athletes with ventricular arrhythmias (VAs), such as ventricular premature beats (VPBs) or nonsustained ventricular tachycardia, can participate in all forms of competitive sports if they have a structurally normal heart and no evidence of molecular/genetic or inflammatory disorders.
      • Zipes D.P.
      • Link M.S.
      • Ackerman M.J.
      • Kovacs R.J.
      • Myerburg R.J.
      • Estes III, N.A.
      Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 9: arrhythmias and conduction defects: a scientific statement from the American Heart Association and American College of Cardiology.
      • Heidbuchel H.
      • Arbelo E.
      • D’Ascenzi F.
      • et al.
      Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part 2: ventricular arrhythmias, channelopathies, and implantable defibrillators.
      • Pelliccia A.
      • Sharma S.
      • Gati S.
      • et al.
      2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease.
      This statement is clear, but the problem lies in its implementation: When can we decide that there is an absence of structural abnormalities, channelopathy, genetic cardiomyopathy, or inflammatory disease? Moreover, frequent VPBs can be a marker of underlying disease.
      • Biffi A.
      • Pelliccia A.
      • Verdile L.
      • et al.
      Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes.
      ,
      • Marcus F.I.
      • McKenna W.J.
      • Sherrill D.
      • et al.
      Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task Force Criteria.
      Hence, many sports physicians and cardiologists struggle with the recommendation, wondering how extensive an evaluation of an athlete presenting with VPBs or other VAs should be before a definitive conclusion can be made. It is evident that a more thorough investigation has a higher likelihood to detect any underlying causative mechanism, but this needs to be balanced against the load of investigations for the athlete personally and society at large. This not only has financial implications but can also induce increased anxiety and accidental findings that may lead to unnecessary sports termination or therapeutic decisions.
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Zipes D.P.
        • Link M.S.
        • Ackerman M.J.
        • Kovacs R.J.
        • Myerburg R.J.
        • Estes III, N.A.
        Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 9: arrhythmias and conduction defects: a scientific statement from the American Heart Association and American College of Cardiology.
        J Am Coll Cardiol. 2015; 66: 2412-2423
        • Heidbuchel H.
        • Arbelo E.
        • D’Ascenzi F.
        • et al.
        Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part 2: ventricular arrhythmias, channelopathies, and implantable defibrillators.
        Europace. 2021; 23: 147-148
        • Pelliccia A.
        • Sharma S.
        • Gati S.
        • et al.
        2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease.
        Eur Heart J. 2021; 42: 17-96
        • Biffi A.
        • Pelliccia A.
        • Verdile L.
        • et al.
        Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes.
        J Am Coll Cardiol. 2002; 40: 446-452
        • Marcus F.I.
        • McKenna W.J.
        • Sherrill D.
        • et al.
        Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task Force Criteria.
        Eur Heart J. 2010; 31: 806-814
        • Dello Russo A.
        • Compagnucci P.
        • Casella M.
        • et al.
        Ventricular arrhythmias in athletes: role of a comprehensive diagnostic workup.
        Heart Rhythm. 2022; 19: 90-99
        • Tobert K.E.
        • Bos J.M.
        • Garmany R.
        • Ackerman M.J.
        Return-to-play for athletes with long QT syndrome or genetic heart diseases predisposing to sudden death.
        J Am Coll Cardiol. 2021; 78: 594-604

      Linked Article