fixed complete, heart block may be a phase in the natural history of the development of idiopathic heart block. In our study the results of 24 h ECG monitoring did not differ greatly between group 1 (symptomatic athletic patients) and group 2 (symptom-free normal athletes). Apart from the exceptional case 16 in group 1, we found only 2 patients with documented ventricular pauses longer than 2-5 s. Clinical appreciation of loss of consciousness and accompanying symptoms led us to label the syndrome in group 1 as cardiac syncope and/or Stokes-Adams attacks. Prolonged absence of pulse was witnessed clinically in 2 patients. The complete disappearance of syncope in patients given pacemakers further supports the diagnosis of cardiac syncope. Symptoms subsided completely in 8 unpaced patients; acceleration of basic heart rhythm after they stopped competitive sports is likely to be the reason for the relief of symptoms. This result accords with the findings of Meytes" and Rasmussen.13 The life-threatening condition required pacemaker implantation in 7 patients in group 1. The question of whether these patients will need pacemakers all their lives remains; it must be answered by a future generation of cardiac pacemakers with built-in Holter facilities. The normal 'athlete does not suffer from any discomfort correlated with bradycardia, pauses/or both. We believe that there is no reason for warnings against competitive sports. Recent case-reports and rumours tend to myth.17 In our group 2 athletes we found only minor abnormalities. Schnohr obtained information about 297 (96' 7%) of 307 male athletic champions born in Denmark between 1880 and 1910 and compared their mortality with that in the general Danish male population.18 The athletic champions had a significantly lower mortality than the general population under the age of 50 years; after 50 years of age the mortality was the same. The causes of death were the same as in the general population.

No abstract