Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
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Review
The athlete's heart is a proarrhythmic heart, and what that means for clinical decision making.
Recurring questions when dealing with arrhythmias in athletes are about the cause of the arrhythmia and, more importantly, about the eligibility of the athlete to continue sports activities. In essence, the relation between sports and arrhythmias can be understood along three lines: sports as arrhythmia trigger on top of an underlying problem, sports as arrhythmic substrate promotor, or sports as substrate inducer. Often, there is no sharp divider line between these entities. ⋯ This review describes the changes in the athlete's heart that are related to arrhythmic expression and focuses on what this concept means for clinical decision making. The concept of the athlete's heart as a proarrhythmic heart creates a framework for evaluation and counselling of athletes, yet also highlights the difficulty in predicting the magnitude of associated risk. The management uncertainties are discussed for specific conditions like extreme bradycardic remodelling, atrioventricular nodal reentrant tachycardia, atrial fibrillation and flutter, and ventricular arrhythmias.