Copyright © 2003 by the European Society of Cardiology.
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High prevalence of right ventricular involvementin endurance athletes with ventricular arrhythmias
Role of an electrophysiologic study in risk stratification
a Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
b Department of Cardiology, Maxima Medical Centrum, Veldhoven, Netherlands
c Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
d Members of the Cardiological Committee of the Union Cycliste Internationale (U.C.I.), Belgium
* Correspondence to: Hein Heidbüchel, M.D., Ph.D., Department of Cardiology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. Tel: 32-16-34 42 48; fax: 32-16-34 42 40
E-mail address: Hein.Heidbuchel{at}uz.kuleuven.ac.be
Received 27 January 2003; revised 25 March 2003; accepted 18 April 2003 This paper was guest edited by Prof. Martin Schalij, Leiden University Medical Center, The Netherlands
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 
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.
Key Words: Athlete • Sports • Arrhythmia • Sudden death
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