Key result
A cardiac pause threshold of >3 seconds had low positive predictive value and sensitivity for symptoms, suggesting it should not be used alone to exclude competitive athletes.
Why the study?
Does the 3-second cardiac pause threshold adequately discriminate between asymptomatic and symptomatic competitive athletes?
Systematic Review (n=194)
Does the 3-second cardiac pause threshold adequately discriminate between asymptomatic and symptomatic competitive athletes?
The 3-second cardiac pause threshold recommended by guidelines does not adequately discriminate between asymptomatic and symptomatic competitive athletes and should not be used alone to exclude competitors.
Answers are grounded in this paper and cite their sources.
Questions utility of isolated pauses for athlete exclusion; leaves open need for symptom-integrated risk models in sports cardiology.
AIMS: It is generally recommended that individuals aspiring to competitive sports should undergo pre-participation cardiovascular assessment, particularly including arrhythmia risk evaluation. In regard to bradyarrhythmias, the 36th Bethesda Conference suggested that asymptomatic cardiac pauses ≤3 s are 'probably of no significance', whereas longer 'symptomatic' pauses may be abnormal. This study focused on assessing the evidence for the '3 s' threshold. METHODS: A systematic literature search was undertaken including Embase (1980-) and Ovid Medline (1950-). The following MeSH terms were used in the database searches: Cardiac.mp & pause.mp. Additionally, pertinent publications found by review of citation lists of identified publications were examined. Individuals with reversible causes of bradyarrhythmia (e.g. drugs) were excluded. RESULTS: The study population comprised 194 individuals with cardiac pauses of 1.35-30 s. In 120 athletes, specific records for pause durations were provided, but it was not always clear whether pauses occurred at rest. Among these 120 athletes, 106 had pauses ≤3 s, of whom 92 were asymptomatic and 14 were symptomatic. Fourteen athletes had pauses >3 s, of whom nine were asymptomatic and five were symptomatic. There were no deaths during follow-up (7.46 ± 5.1 years). With respect to symptoms, the ≤3 s threshold had a low-positive predictive value (35.7%) and low sensitivity (26.3%), but good negative predictive value (86.7%) and specificity (91%). CONCLUSION: While the evidence is not incontrovertible, the 3 s pause threshold does not adequately discriminate between potentially asymptomatic and symptomatic competitive athletes, and alone should not be used to exclude potential competitors.
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Şentürk et al. (2015) conducted a systematic review in Cardiac pauses in competitive athletes (n=194). Cardiac pauses >3 seconds vs. Cardiac pauses ≤3 seconds was evaluated on Symptoms (PPV 35.7%, sensitivity 26.3%, NPV 86.7%, specificity 91%). A cardiac pause threshold of >3 seconds had low positive predictive value and sensitivity for symptoms, suggesting it should not be used alone to exclude competitive athletes.
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