Ventricular Arrhythmias in Athletes: Role of a Comprehensive Diagnostic Workup

Abstract

BACKGROUND: Ventricular arrhythmias (VAs) represent a critical issue in regard to sports eligibility assessment in athletes. The ideal diagnostic evaluation of competitive and leisure-time athletes with complex VAs has not been clearly defined. OBJECTIVE: To assess the clinical implications of invasive electrophysiological assessments and endomyocardial biopsy among athletes with VAs. METHODS: We evaluated 227 consecutive athletes who presented to our institutions after being disqualified from participating in sports because of VAs. After noninvasive tests, electrophysiology study (EPS), electroanatomical mapping (EAM), and EAM- or cMRI-guided endomyocardial biopsy (EMB) were performed, following a prespecified protocol. Sports eligibility status was redefined at 6-month follow-up. RESULTS: From our sample, 188 (82.8%) athletes underwent EAM and EPS, while 42 (15.2%) underwent EMB. In this latter subset, the invasive diagnostic workup allowed diagnostic reclassification of half of athletes (n=21, 50%). Reclassification was particularly common among subjects without definitive findings after noninvasive evaluation (n=23; 87% reclassified), especially in the presence of cMRI-proven left ventricular (LV) nonischemic scar (n=13; 92% reclassified). History of syncope, abnormal echocardiogram, presence of late gadolinium enhancement, and abnormal EAM were linked to sports ineligibility at six-month follow-up, whereas performance of catheter ablation was associated with sports eligibility. CONCLUSIONS: A comprehensive invasive workup provided important additional diagnostic elements and could improve the sports eligibility assessment of athletes presenting with VAs. The presented extensive invasive evaluation could be routinely performed when noninvasive tests show unclear findings and/or LV nonischemic scar in order to inform athletes' management.