Ventricular arrhythmias and physical activity: Risk stratification and decision whether to continue playing sport

Ventricular arrhythmias (VA) may occasionally be detected in athletes. They most commonly manifest as premature ventricular contractions (PVC), while ventricular tachycardia (VT) is less frequently observed. In most cases, VAs have a benign prognosis and do not require specific treatment, but rather periodic follow-up. However, VA may occasionally represent an early sign of underlying structural heart disease. The assessment of VA in competitive athletes requires an integrated approach. Symptoms like syncope will be very important as well as family history of premature sudden cardiac death. Analysis of the 12-lead ECG is very important, because its abnormalities may suggest the presence of cardiomyopathy or channelopathy. Ambulatory ECG monitoring is the method of choice for determining the frequency and complexity of VA. Echocardiography is an important first-line imaging modality for the rapid and reliable assessment of cardiac chamber structure and function. Exercise testing is a valuable tool for assessing the frequency of VA and their response to physical exertion. Cardiac magnetic resonance can detect subtle structural abnormalities, including myocardial fibrosis and infiltrative changes, which may represent a substrate for VA. Genetic testing plays an important role when an inherited arrhythmic syndrome is suspected. In selected cases, an invasive electrophysiological study may be required for a comprehensive evaluation of VA. The presence of isolated PVC in the absence of structural or electrical heart disease is generally associated with a favorable prognosis. In contrast, the presence of complex VA requires appropriate risk stratification.