Abstract
The prediction and prevention of sudden cardiac death is the philosopher’s stone of clinical cardiac electrophysiology. Sports can act as triggers of fatal arrhythmias and therefore it is essential to promptly frame the athlete at risk and to carefully evaluate the suitability for both competitive and recreational sports activity. A history of syncope or palpitations, the presence of premature ventricular complexes or more complex arrhythmias, a reduced left ventricular systolic function, or the presence of known or familiar heart disease should prompt a thorough evaluation with second level examinations. In this regard, cardiac magnetic resonance and electrophysiological study play important roles in the diagnostic work-up. The role of genetics is increasing both in cardiomyopathies and in channelopathies, and a careful evaluation must be focused on genotype positive/phenotype negative subjects. In addition to being a trigger for fatal arrhythmias in certain cardiomyopathies, sports also play a role in the progression of the disease itself, especially in the case arrhythmogenic right ventricular cardiomyopathy. In this paper, we review the latest European guidelines on sport cardiology in patients with cardiovascular diseases, focusing on arrhythmic risk stratification and the management of cardiomyopathies and channelopathies.
Highlights
Cardiovascular diseases are a significant cause of sudden cardiac death (SCD) in athletes, and exercise may be a trigger for fatal arrhythmias, with an annual incidence of about 1/200,000 [1]
The exercise stress test is the most widespread screening test in many countries, more advanced investigations may be required in specific settings
According to the recent European guidelines on sport activity in patients with heart disease, a more liberal use of cardiac magnetic resonance imaging and electrophysiological study should be considered in many different conditions (Table 1), both in the risk stratification phase and in the phase of return to physical activity, whenever possible
Summary
Cardiovascular diseases are a significant cause of sudden cardiac death (SCD) in athletes, and exercise may be a trigger for fatal arrhythmias, with an annual incidence of about 1/200,000 [1]. The identification of athletes with cardiomyopathies or channelopathies has important implications for participation in sports activities, especially with regard to the prevention of fatal events. Exercise intensity represents a critical variable in athletes with cardiovascular diseases, and it is related to metabolic equivalents (METs) or percentage of maximal aerobic capacity (VO2 max) during sports activity. We present a practical approach to athletes with heart diseases that have a potentially increasing risk of fatal arrhythmias during sports activity, according to the latest European Society of Cardiology (ESC) guidelines [2]
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