Wide Spectrum of Bradyarrhythmias and Supraventricular Tachyarrhythmias in Sportsmen: Run Forrest, Run?!

TL;DR

This paper reviews how sports can cause heart rhythm issues like bradycardia and atrial fibrillation in athletes, and the challenges in managing these conditions.

Contribution

The paper provides a comprehensive review of the relationship between sports participation and arrhythmias, focusing on clinical management challenges in athletes.

Findings

Endurance athletes, especially males, have an increased risk of atrial fibrillation influenced by age.

Bradyarrhythmias like sinus bradycardia are common in athletes but are often managed without restricting sports participation.

Pacemaker implantation may be necessary for symptomatic bradycardia due to sinus node dysfunction.

Abstract

The intricate relationship between sports participation and cardiac arrhythmias
is a key focus of cardiovascular research. Physical activity, integral to
preventing atherosclerotic cardiovascular disease, induces structural,
functional, and electrical changes in the heart, potentially triggering
arrhythmias, particularly atrial fibrillation (AF). Despite the cardiovascular
benefits, the optimal exercise amount remains unclear, revealing a J-shaped
association between AF and exercise. Endurance athletes, particularly males, face
elevated AF risks, influenced by age. Risk factors vary among sports modalities,
with unique physiological responses in swim training potentially elevating AF
risk. Clinical management of AF in athletes necessitates a delicate balance
between rhythm control, rate control, and anticoagulation therapy. Sport-induced
bradyarrhythmias, including sinus bradycardia and conduction disturbances, are
prevalent among athletes. Managing bradycardia in athletes proves challenging due
to its complex and not fully understood pathophysiology. Careful consideration is
required, particularly in symptomatic cases, where pacemaker implantation may be
necessary for sinus node dysfunction. Although pacing is recommended for specific
atrioventricular (AV) blocks, milder forms often prevail without restricting sports participation.
This review explores the nuanced relationship between exercise and tachy- and
bradyarrhythmia in athletes, addressing the challenges clinicians face when
optimizing patient care in this distinctive population.

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