Stanford Cardiac Arrhythmia Service

Arrhythmias in Athletes

There are no known arrhythmias that only occur in athletes. However, in general, the constant demands on the heart imposed by the athlete’s physical activity may increase the likelihood of several arrhythmias, as well as several structural abnormalities that are associated with arrhythmias.

Atrial fibrillation may be more prevalent in long distance athletes. Right ventricular cardiomyopathy or dysplasia (ARVC or ARVD) appears to be more prevalent in athletes, and episodes of ventricular tachycardia (VT) are often triggered during exercise. In both of these arrhythmias, there is some suggestion that the repeated strain on the heart from strenuous exertion may lead to structural changes that predispose to these arrhythmias. In the case of ARVC/ARVD, the underlying genetic condition may be brought out by the strain of exercise.

Sudden death in athletes is rare, but incidents that do occur often receive significant attention from the lay press. There are many potential heart-related causes of sudden death in the athlete, and some of these are arrhythmia-related. The most common definable cause of sudden death in athletes is ventricular arrhythmias resulting from hypertrophic cardiomyopathy . HCM is a genetic condition that results in abnormal thickening of the ventricles, which then predisposes to ventricular arrhythmias.

Question: I am an athletic individual. Am I at risk for arrhythmia or sudden death?

Answer: In general, moderate exercise does not predispose to an increased risk of arrhythmia or sudden death. However, those patients with these underlying conditions may bring out these disease conditions. In addition, there is some epidemiologic data that suggests an increased risk of atrial fibrillation in those who exercise regularly and vigorously.
In general, symptoms brought on by exercise, including palpitations, shortness of breath, chest pain, dizziness or fainting, should prompt medical attention. Initial evaluation may include an ECG, stress test, home heart monitor (Holter or event recorder), or an echocardiogram. If indicated, additional testing may include a cardiac MRI, coronary angiography, or electrophysiologic study.

 

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