CLINICAL STUDY
Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes
Alessandro Biffi, MD*,*,
Antonio Pelliccia, MD*,
Luisa Verdile, MD*,
Fredrick Fernando, MD*,
Antonio Spataro, MD*,
Stefano Caselli, MD*,
Massimo Santini, MD and
Barry J. Maron, MD, FACC
* Institute of Sports Science, Department of Medicine, Italian National Olympic Committee, Rome, Italy
San Filippo Neri Hospital, Department of Heart Disease, Rome, Italy
Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
Manuscript received June 1, 2001;
revised manuscript received February 7, 2002,
accepted April 30, 2002.
* Reprint requests and correspondence: Dr. Alessandro Biffi, Department of Medicine, Institute of Sports Science, Via dei Campi Sportivi, 46, Rome, Italy 00197.
a.biffi{at}libero.it
OBJECTIVES: The aim of this study was to clarify the clinical relevance of ventricular tachyarrhythmias assessed by 24-h ambulatory electrocardiograms (ECG) in a large, unique, and prospectively evaluated athletic population.
BACKGROUND: For athletes with ventricular tachyarrhythmias, the risk of sudden cardiac death associated with participation in competitive sports is unresolved.
METHODS: We assessed 355 competitive athletes with ventricular arrhythmias (VAs) on a 24-h ambulatory (Holter) ECG that was obtained because of either palpitations, the presence of  3 premature ventricular depolarizations (PVDs) on resting 12-lead ECG, or both.
RESULTS: Athletes were segregated into three groups: Group A with 2,000 PVDs/24 h (n = 71); Group B with 100 <2,000 PVDs/24 h (n = 153); and Group C with only <100 PVDs/24 h (n = 131). Cardiac abnormalities were detected in 26 of the 355 study subjects (7%) and were significantly more common in Group A (21/71, 30%) than in Group B (5/153, 3%) or Group C athletes (0/131, 0% p < 0.001). Only the 71 athletes in Group A were excluded from competition. During follow-up (mean, 8 years), 70 of 71 athletes in Group A and each of the 284 athletes in Groups B and C have survived without cardiovascular events. The remaining Group A athlete died suddenly of arrhythmogenic right ventricular cardiomyopathy while participating in a field hockey game against medical advice.
CONCLUSIONS: Frequent and complex ventricular tachyarrhythmias are common in trained athletes and are usually unassociated with underlying cardiovascular abnormalities. Such VAs (when unassociated with cardiovascular abnormalities) do not convey adverse clinical significance, appear to be an expression of "athlete’s heart syndrome," and probably do not per se justify a disqualification from competitive sports.
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Abbreviations and Acronyms
| | ARVC | | arrhythmogenic right ventricular cardiomyopathy | | ECG | | electrocardiogram | | EP | | electrophysiologic | | LBBB | | left bundle branch block | | MRI | | magnetic resonance imaging | | NSVT | | nonsustained ventricular tachycardia | | PVD | | premature ventricular depolarization | | VA | | ventricular arrhythmia | | VT | | ventricular tachycardia |
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