148 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE
ARRHYTHMIAS IN ATHLETES
- Lethal cardiac arrhythmias represent the most serious
risk for sudden death in athletes. Symptoms of a
potential arrhythmia may include syncope, near syn-
cope, palpitations, exertional chest discomfort, severe
dyspnea, or uncommon exertional fatigue.
EVALUATION
- Structural heart disease must be ruled out before the
athlete is allowed to return to sports (Maron and
Mitchell, 1994; Kugler and O’Connor, 1999;
Luckstead, 2002). This will include a meticulous his-
tory, physical examination, and EKG and may be fol-
lowed by chest X-ray, echocardiogram, stress test,
Holter monitoring, electrolytes, and other laboratory
testing. - It may very well include early referral to a cardiolo-
gist for electrophysiologic study and/or ongoing man-
agement.
SPORTS PARTICIPATION•Various arrhythmias are compatible with competi-
tive sports once they are diagnosed and controlled.
See Table 25-10 for a summary of the common dys-
rhythmias and the recommendations from the 26th
Bethesda Conference (Maron and Mitchell, 1994).- The Committee on Sports Medicine and Fitness for
the American Academy of Pediatrics specifically
recommends that the presence of a symptomatic
dysrhythmia requires exclusion from physical
activity until the athlete’s problem can be ade-
quately evaluated by a cardiologist and controlled
(Committee on Sports Medicine and Fitness, 1995).
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cine, 2nd ed. Boston, MA, Butterworth/Heinemann, 1999, p 339.TABLE 25-10 Activity Recommendations
for the Common Dysrhythmias
ACTIVITY RECOMMENDATIONS
Disturbances of sinus node No symptoms, no treatment; if
function (includes sinus symptoms require pacemaker, then
bradycardia, tachycardia, no collision sports
arrhythmia, arrest, exit
block; sick sinus syndrome)
Premature atrial complexes No restrictions
Atrial flutter and atrial If no structural heart disease and rate
fibrillation controlled by drugs, then
low-intensity sports; if no flutter or
fibrillation for 6 months, then full
participation
Supraventricular tachycardia If episodes are prevented by drugs,
then full participation; if structural
disease and if syncope or
pre-syncope, no competitive sports;
reconsider after 6 mos without
recurrence
Ventricular pre-excitation If no structural heart disease and no
(WPW) symptoms, then no limit; if
structuralheart disease and PVCs
worsen with exercise, restrict;
PVCs plus prolonged QT interval
should be restricted (high risk for
sudden death)
Heart blocks (first-degree or If no symptoms and no structural
Mobitz I second-degree) disease, then no restrictions
Heart blocks (Mobitz II If no symptoms and no structural
second degree or third disease, then no restrictions if rate
degree) 40–80; if symptoms then pacer and
avoid collision sports
Congenital long Q-T Restrict from all competitive sports
Syndrome (High risk for death)
SOURCE: (Maron and Mitchell, 1994; Kugler and O’Connor, 1999)