Key result
Frequent PVDs in athletes are linked to a 30% cardiac abnormality rate but rarely cardiovascular events.
Why the study?
For athletes with ventricular tachyarrhythmias, the risk of sudden cardiac death associated with participation in competitive sports is unresolved.
Do frequent and complex ventricular tachyarrhythmias increase the risk of cardiovascular events or sudden cardiac death in trained athletes?
Cohort (n=355)
Do frequent and complex ventricular tachyarrhythmias increase the risk of cardiovascular events or sudden cardiac death in trained athletes?
p-value: p=<0.001
Frequent ventricular arrhythmias in trained athletes are usually not associated with underlying cardiovascular abnormalities and do not convey adverse clinical significance, suggesting they may not justify disqualification from competitive sports.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Arrhythmia burden is also important, as one study on PVCs in athletes from over 20 years ago found that 30% of athletes with >2,000 PVCs per day had structural abnormalities compared with 3% of those with 100-2,000 PVCs and none with <100 PVCs.”
May not justify disqualification for frequent VAs in athletes; leaves open prospective validation of SCD risk.
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 > or = 3 premature ventricular depolarizations (PVDs) on resting 12-lead ECG, or both. RESULTS: Athletes were segregated into three groups: Group A with > or = 2,000 PVDs/24 h (n = 71); Group B with > or = 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. 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.
No takes yet. Share an insight, caveat, or question.
Biffi et al. (2002) conducted a cohort in Ventricular arrhythmias in competitive athletes (n=355). Frequent premature ventricular depolarizations (≥2,000 PVDs/24 h) vs. <2,000 PVDs/24 h was evaluated on Cardiac abnormalities (p=<0.001). Frequent premature ventricular depolarizations (≥2,000 PVDs/24 h) in athletes were associated with more cardiac abnormalities (30% vs 3% or 0%, p<0.001) but rarely led to cardiovascular events.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: