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Lampert R, Chung EH, Ackerman MJ, Arroyo AR, Darden D, Deo R, Dolan J, Etheridge SP, Gray BR, Harmon KG, James CA, Kim JH, Krahn AD, La Gerche A, Link MS, MacIntyre C, Mont L, Salerno JC, Shah MJ. 2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play. Heart Rhythm 2024; 21:e151-e252. [PMID: 38763377 DOI: 10.1016/j.hrthm.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
Youth and adult participation in sports continues to increase, and athletes may be diagnosed with potentially arrhythmogenic cardiac conditions. This international multidisciplinary document is intended to guide electrophysiologists, sports cardiologists, and associated health care team members in the diagnosis, treatment, and management of arrhythmic conditions in the athlete with the goal of facilitating return to sport and avoiding the harm caused by restriction. Expert, disease-specific risk assessment in the context of athlete symptoms and diagnoses is emphasized throughout the document. After appropriate risk assessment, management of arrhythmias geared toward return to play when possible is addressed. Other topics include shared decision-making and emergency action planning. The goal of this document is to provide evidence-based recommendations impacting all areas in the care of athletes with arrhythmic conditions. Areas in need of further study are also discussed.
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Affiliation(s)
- Rachel Lampert
- Yale University School of Medicine, New Haven, Connecticut
| | - Eugene H Chung
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Rajat Deo
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Joe Dolan
- University of Utah, Salt Lake City, Utah
| | | | - Belinda R Gray
- University of Sydney, Camperdown, New South Wales, Australia
| | | | | | | | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jack C Salerno
- University of Washington School of Medicine, Seattle, Washington
| | - Maully J Shah
- Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
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2
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Vine M, Daucourt C, Besson C, Neyroud D, Kayser B, Meyer P, Graf G, Gabus V, Gremeaux V, Muller O, Baggish AL. Cardiovascular risk factors among endurance masters athletes from Switzerland. Eur J Prev Cardiol 2024:zwae287. [PMID: 39302882 DOI: 10.1093/eurjpc/zwae287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Accepted: 08/27/2024] [Indexed: 09/22/2024]
Affiliation(s)
- Morgane Vine
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1005 Lausanne, Switzerland
| | - Chantal Daucourt
- Department of Sports Medicine, Swiss Olympic Medical Center, Rue du Bugnon 46, 1005 Lausanne University Hospital, Lausanne, Switzerland
| | - Cyril Besson
- Department of Sports Medicine, Swiss Olympic Medical Center, Rue du Bugnon 46, 1005 Lausanne University Hospital, Lausanne, Switzerland
| | - Daria Neyroud
- Institute of Sports Sciences, University of Lausanne, Synathlon - Quartier Centre, 1015 Lausanne, Switzerland
| | - Bengt Kayser
- Institute of Sports Sciences, University of Lausanne, Synathlon - Quartier Centre, 1015 Lausanne, Switzerland
| | - Philippe Meyer
- Division of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Guillaume Graf
- Clinique La Lignière, La Lingière 5, 1196 Gland, Switzerland
| | - Vincent Gabus
- Departments of Cardiology, l'Hôpital Riviera Chablais, Rennaz, Switzerland
| | - Vincent Gremeaux
- Department of Sports Medicine, Swiss Olympic Medical Center, Rue du Bugnon 46, 1005 Lausanne University Hospital, Lausanne, Switzerland
- Institute of Sports Sciences, University of Lausanne, Synathlon - Quartier Centre, 1015 Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1005 Lausanne, Switzerland
| | - Aaron L Baggish
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1005 Lausanne, Switzerland
- Department of Sports Medicine, Swiss Olympic Medical Center, Rue du Bugnon 46, 1005 Lausanne University Hospital, Lausanne, Switzerland
- Institute of Sports Sciences, University of Lausanne, Synathlon - Quartier Centre, 1015 Lausanne, Switzerland
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Pingitore A, Peruzzi M, Clarich SC, Palamà Z, Sciarra L, Cavarretta E. An overview of the electrocardiographic monitoring devices in sports cardiology: Between present and future. Clin Cardiol 2023; 46:1028-1037. [PMID: 37349944 PMCID: PMC10540029 DOI: 10.1002/clc.24073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Athletes represent a mainly healthy population, which however could be considered at risk of major arrhythmic events, especially in case of undiagnosed cardiomyopathies. For this reason, the periodical sports medicine examination and the electrocardiography are essential tools in the cardiovascular screening, even though they do not always succeed in identifying rhythm disturbances, particularly when asymptomatic or rarely symptomatic. HYPOTHESIS Prolonged cardiac monitoring often enables clinicians to stratify the arrhythmic risk and reach the diagnosis. The technological progress of the last decades has produced an always-increasing number of heart rhythm monitoring devices, starting from the 24-hour electrocardiogram Holter monitoring and ending with the wide world of wearable devices. METHODS In the literature, the extreme utility of this equipment in the patients affected by cardiovascular diseases and in the general population is well established. On the contrary, athletes-based randomized trials or large-scale epidemiological studies targeting the frequency of cardiac symptoms and the use of cardiac monitoring are missing, while an ever-growing number of case series and small observational studies are flourishing in recent years. RESULTS The present review showcases the available electrocardiographic monitoring options, principally in the medical setting, listing their characteristics, their indications, their supporting evidence, and their general pros and cons. CONCLUSIONS The ultimate goal of this review is guiding physicians through the wide variety of heart rhythm monitoring options in the specific subfield of sports cardiology, when an arrhythmia is suspected in an athlete, to tailor the diagnostic process and favor the best diagnostic accuracy.
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Affiliation(s)
- Annachiara Pingitore
- Department of General and Specialistic Surgery “Paride Stefanini”Sapienza University of RomeRomeItaly
| | - Mariangela Peruzzi
- Department of Clinical Internal, Anesthesiology and Cardiovascular SciencesSapienza University of RomeRomeItaly
- Mediterranea CardiocentroNaplesItaly
| | | | - Zefferino Palamà
- Electrophysiology Service, Division of CardiologyCasa di Cura Villa VerdeTarantoItaly
- Department of Clinical Medicine, Public Health, Life and Environmental SciencesUniversity of L'AquilaCoppitoItaly
| | - Luigi Sciarra
- Department of Clinical Medicine, Public Health, Life and Environmental SciencesUniversity of L'AquilaCoppitoItaly
| | - Elena Cavarretta
- Mediterranea CardiocentroNaplesItaly
- Department of Medical‐Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
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Lobo HM, Naves ÍG, Marçal SB, Canzi CC, Rodrigues ABS, Menezes Jr AS. Atrial Fibrillation in Endurance Training Athletes: Scoping Review. Rev Cardiovasc Med 2023; 24:155. [PMID: 39077536 PMCID: PMC11264108 DOI: 10.31083/j.rcm2406155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/11/2023] [Accepted: 02/28/2023] [Indexed: 07/31/2024] Open
Abstract
Background Moderate regular physical activity is indicated to avoid atrial fibrillation (AF), whereas athletes should be counseled that long-lasting vigorous sports engagement may cause AF, according to the 2016 European Society of Cardiology (ESC) recommendations for AF treatment. Exercise and AF are complex. Objectives To evaluate the relationship between Endurance training and AF, in addition to the starting point/trigger by which Endurance Training causes impairment of cardiac function and AF, considering the time and intensity of Endurance training. Materials and Methods We synthesized evidence from articles published in the PubMed, EMBASE, and SciELO databases using their respective Boolean operators. A total of 112 original articles related to AF and endurance athletes published up to the year 2023 were reviewed. Results Our study verified multiples aspects of the genesis of AF in athletes, such as cardiac adaptations to exercise, disturbances in cardiac injury biomarkers, sex differences in cardiac adaptations and their role in AF risk, and the relationship between body composition (height, weight, and physical fitness) and AF pathogenesis. Conclusions Variations in cardiac structure (increased atrial thickness and size in addition to myocardial fibrosis) and significant increases in vagal tone (sinus bradycardia and imbalances in sympathetic and parasympathetic activation) shorten the refractory period shortening in athletes, induce the onset of re-entrance mechanisms, and serve as ectopic triggers that can lead to AF.
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Affiliation(s)
- Henrique M. Lobo
- Medical and Life Sciences School, Pontifical Catholic University of Goiás, 74175-120 Goiânia, Goiás, Brazil
| | - Ícaro G. Naves
- Medical and Life Sciences School, Pontifical Catholic University of Goiás, 74175-120 Goiânia, Goiás, Brazil
| | - Silvia Botelho Marçal
- Internal Medicine Department, Medicine Faculty, Federal University of Goiás, 74690-900 Goiânia, Goiás, Brazil
| | - Camila Cassia Canzi
- Medical and Life Sciences School, Pontifical Catholic University of Goiás, 74175-120 Goiânia, Goiás, Brazil
| | | | - Antonio S. Menezes Jr
- Medical and Life Sciences School, Pontifical Catholic University of Goiás, 74175-120 Goiânia, Goiás, Brazil
- Internal Medicine Department, Medicine Faculty, Federal University of Goiás, 74690-900 Goiânia, Goiás, Brazil
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Rothschild CE. Exercise Considerations for the Masters Female Athlete. Strength Cond J 2022. [DOI: 10.1519/ssc.0000000000000743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Patel VI, Gradus-Pizlo I, Malik S, Barseghian El-Farra A, Dineen EH. Cardiodiagnostic sex-specific differences of the female athlete in sports cardiology. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 17:100149. [PMID: 38559879 PMCID: PMC10978368 DOI: 10.1016/j.ahjo.2022.100149] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 04/04/2024]
Abstract
The cardiovascular care of highly active individuals and competitive athletes has developed into an important focus within the field of sports medicine. An evolving understanding of exercise-induced cardiovascular remodeling in athletes has led to a more robust characterization of physiologic adaptation versus pathological dysfunction, but this distinction is often challenging due to diagnostic commonalities. Current data reflects sporting-focused analyses of mainly male athletes, which may not be easily applicable to the female athletic heart. Increasingly female-specific cardiac dimensional and physiologic data are starting to emerge from comparative studies that may be utilized to address this growing need, and further guide individualized care. Here, we review current literature evaluating female-specific cardiovascular adaptations of the athletic heart, and formulate a discussion on cardiac remodeling, cardiodiagnostic findings, etiologic mechanisms, limitations of currently available data, and direction for future research in the cardiovascular care of female athletes.
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Affiliation(s)
- Vishal I. Patel
- Corresponding author at: Division of Cardiology, Department of Internal Medicine, University of California, Irvine, School of Medicine, 101 The City Drive South, Building 200, Room 414, Orange, CA 92868, United States of America.
| | - Irmina Gradus-Pizlo
- Division of Cardiology, University of California, Irvine, School of Medicine, Orange, CA 92868, United States of America
- Susan Samueli Integrative Health Institute, UCI Health, Orange, CA 92868, United States of America
| | - Shaista Malik
- Division of Cardiology, University of California, Irvine, School of Medicine, Orange, CA 92868, United States of America
- Susan Samueli Integrative Health Institute, UCI Health, Orange, CA 92868, United States of America
| | - Ailin Barseghian El-Farra
- Division of Cardiology, University of California, Irvine, School of Medicine, Orange, CA 92868, United States of America
- Susan Samueli Integrative Health Institute, UCI Health, Orange, CA 92868, United States of America
| | - Elizabeth H. Dineen
- Division of Cardiology, University of California, Irvine, School of Medicine, Orange, CA 92868, United States of America
- Susan Samueli Integrative Health Institute, UCI Health, Orange, CA 92868, United States of America
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Catapano M, Ahmed M, Breslow RG, Borg-Stein J. The aging athlete. PM R 2022; 14:643-651. [PMID: 35441493 DOI: 10.1002/pmrj.12814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/09/2022]
Abstract
Aging athletes, those 60 years and older, are a growing population of mature, active individuals who value sports and exercise participation throughout their lifespan. Although recommendations for younger and masters athletes have been extrapolated to this population, there remains a paucity of specific guidelines, treatment algorithms, and considerations for aging athletes. The benefits of living an active lifestyle must be weighed against the risks for unique cardiovascular, metabolic, and musculoskeletal injuries requiring diagnostic and therapeutic interventions. In this article, we review the unique cardiovascular and muscular physiology of aging athletes and how it influences the risk of specific medical conditions. We also discuss general prevention and treatment strategies. Finally, we identify areas of future research priorities and emerging treatments.
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Affiliation(s)
- Michael Catapano
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA.,Division of Sports Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marwa Ahmed
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA.,Division of Sports Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Joanne Borg-Stein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts, USA.,Division of Sports Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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A New Approach for Evaluation of Cardiovascular Fitness and Cardiac Responses to Maximal Exercise Test in Master Runners: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11061648. [PMID: 35329974 PMCID: PMC8955590 DOI: 10.3390/jcm11061648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 01/08/2023] Open
Abstract
The aim of this study was to analyze the cardiac autonomic function at rest, at maximum exercise, and in recovery after exercise and to determine sex-specific and age-specific values for resting heart rate (RHR), hear rate (HR)-peak, HR recovery (HRR), and HR variability at rest in master runners. Fifty endurance runners (21 women) participated in this study (43.28 ± 5.25 years). The subjects came from different athletic clubs in Andalusia (Spain), and the testing protocol was performed in-season. A 3-km running test was performed and the cardiovascular response was monitored. Regarding sex, no significant differences were found regarding cardiovascular autonomic function at rest, during exercise, and following maximal exercise, only at rest, the standard deviation of all R-R intervals and low frequency values displayed significantly (p < 0.05) lower scores in women. 46% of athletes showed an RHR < 60 bpm. Additionally, HR-peak showed a significant correlation with age (r = −0.369; p = 0.009) and HRR5min (r = 0.476, p = 0.001). Also, endurance performance was inversely associated with obesity traits and cardiometabolic risk factors. In summary, age, sex, fitness, or anthropometrics characteristics did not show a relevant influence on cardiovascular autonomic modulation in master runners. However, the 3-km performance displayed a significant negative association with several factors of cardiometabolic risk.
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Ganse B, Degens H. Current Insights in the Age-related Decline in Sports Performance of the Older Athlete. Int J Sports Med 2021; 42:879-888. [PMID: 34000751 DOI: 10.1055/a-1480-7730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The higher performance level of master athletes compared to non-athletes is often associated with better health throughout life. However, even the physical performance of master athletes declines with age, and this decline accelerates from about the age of 70 years onwards. A progressive loss of muscle mass, declines in force- and power-generating capacity, decreased flexibility, and the concomitant decline in specific tension characterize the muscular changes underlying performance declines. In the cardiovascular system, declines in stroke volume and cardiac output, and cardiac and vascular stiffness contribute to decreasing performance. Recent studies have shown that long-term endurance exercise in master athletes does not only have positive effects, but is associated with an increased incidence of atrial fibrillation, atherosclerotic plaques, and aortic dilation, and even more so in men than in women. Recently, larger longitudinal datasets were analysed and showed that the age-related decline in performance was similar in longitudinal and cross-sectional data. In conclusion, regular physical activity enhances the exercise capacity, and hence quality of life in old age, but it is not without risks.
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Affiliation(s)
- Bergita Ganse
- Research Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University, Manchester, United Kingdom of Great Britain and Northern Ireland.,Innovative Implant Development, Clinics and Institutes of Surgery, Universität des Saarlandes, Homburg, Germany
| | - Hans Degens
- Research Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University, Manchester, United Kingdom of Great Britain and Northern Ireland.,Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
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10
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Affiliation(s)
- M Carmen Adamuz
- Sports Medicine Department, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, P.O. Box 29222, Doha, Qatar
| | - Domingo Pascual Figal
- Head of Cardiology Department, Hospital Virgen de la Arrixaca, University of Murcia, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Murcia, Spain.
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