Key result
Sinus bradycardia affects up to ~90% of endurance athletes, with wearables aiding arrhythmia detection.
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Alerts clinicians to common bradycardia in athletes; leaves open wearable ECG thresholds and management pending validation.
The morphological and functional cardiac adaptations induced by regular endurance training may be reflected in several athletes’ electrocardiographic variants [1]. Rhythm and heart rate disturbances, high QRS voltage, ST segment elevation in the so called “early repolarization,” vagotonic or high T wave voltages, first degree AV block, incomplete right bundle branch block (RBBB) are the most common findings. Sinus bradycardia is the most frequent adaptation [2]. A detailed description of the athlete’s heart adaptation to effort and most common ECG changes at athletes can be found in numerous papers in the second half of the 20th century [3-5] and an extensive description of athletes’ heart ECG is out of the scope of the present chapter. An excellent review of the present interpretation of ECG in athletes and practical recommendations for physicians has been recently published by a recognized group of international experts [6].
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Robert Gajda (2019) conducted a review in Extreme bradycardia and bradyarrhythmias in endurance athletes. Heart rate monitors and wearable ECG technologies vs. Standard Holter ECG monitoring and clinical evaluation was evaluated. Sinus bradycardia (<50 bpm) occurs in 50-90% of endurance athletes, and emerging wearable ECG devices alongside Holter monitoring aid in detecting extreme bradyarrhythmias and prolonged pauses.
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