This comprehensive case analysis aimed to identify the features enabling a runner to achieve championship in 24-h ultramarathon (UM) races. A 36-year-old, multiple medalist of the World Championships in 24-h running, was assessed before, one and 10 days after a 24-h run. Results of his extensive laboratory and cardiological diagnostics with transthoracic echocardiography (TTE) and a one-time cardiopulmonary exercise test (CPET) were analyzed. After 12 h of running (approximately 130 km), the athlete experienced an increasing pain in the right knee. His baseline clinical data were within the normal range. High physical efficiency in CPET (VO2max 63 mL/kg/min) was similar to the average achieved by other ultramarathoners who had significantly worse results. Thus, we also performed genetic tests and assessed his psychological profile, body composition, and markers of physical and mental stress (serotonin, cortisol, epinephrine, prolactin, testosterone, and luteinizing hormone). The athlete had a mtDNA haplogroup H (HV0a1 subgroup, belonging to the HV cluster), characteristic of athletes with the highest endurance. Psychological studies have shown high and very high intensity of the properties of individual scales of the tools used mental resilience (62–100% depending on the scale), openness to experience (10th sten), coherence (10th sten), positive perfectionism (100%) and overall hope for success score (10th sten). The athlete himself considers the commitment and mental support of his team to be a significant factor of his success. Body composition assessment (%fat 13.9) and the level of stress markers were unremarkable. The tested athlete showed a number of features of the champions of ultramarathon runs, such as: inborn predispositions, mental traits, level of training, and resistance to pain. However, none of these features are reserved exclusively for “champions”. Team support’s participation cannot be underestimated. The factors that guarantee the success of this elite 24-h UM runner go far beyond physiological and psychological explanations. Further studies are needed to identify individual elements of the putative “mosaic theory of being a champion”.

Introduction: For many years, many athletes have reported to the Centre for Sports Cardiology in Pułtusk that during endurance training, mainly running and cycling, they found unexpected increases in heart rate (HR) values observed on sports heart rate monitors (HRMs), in the vast majority of cases without the accompanying clinical symptoms. The authors have attempted to answer the question of whether the "arrhythmia" observed on HRMs is a rhythm disturbance or a mere technical artefact. The aim of the study: This article aimed to summarize the authors' observations in the field of the usefulness of HRMs for the assessment of cardiac arrhythmias in the situation of introducing new technological solutions in the modernized and enriched ones with new functions HRMs. Material and methods: Over ten years, numerous studies have been carried out and the world literature has been also analysed many times, finally describing the authors' study results and observations in numerous types of English-language articles published between 2017 and 2021. In this review article, the authors focused only on their publications from the Centre for Sports Cardiology in Pułtusk on the issues of heart rhythm disturbances observed on HRMs by endurance athletes, and on publications in which researchers from CKS participated and the articles themselves were related with the use of HRMs. Only a few references have been cited from other sources. Conclusions: The HRMs used in the past years were not significant for the treatment of asymptomatic exercise-stimulated arrhythmias. These HRMs, however, in a symptomatic arrhythmia situation, became an effective diagnostic tool confirming its occurrence. The analysis of cases and literature shows that modern sports heart rate monitors used by athletes of endurance disciplines (especially with the possibility of ECG recording) are becoming a useful, important and more and more effective diagnostic tool in the detection and final diagnosis of cardiac arrhythmias stimulated by exercise, both symptomatic and asymptomatic athletes and can significantly contribute to the increase of safety during training. It can be assumed that future HRMs will have comparable diagnostic value in detecting cardiac arrhythmias as the Holter ECG, surpassing them with the possibility of constant data transmission, ease of use and affordable price.

This article has been peer reviewed and published immediately upon acceptance.It is an open access article, which means that it can be downloaded, printed, and distributed freely, provided the work is properly cited. Articles in "Cardiology Journal" are listed in PubMed.

Heart rate monitors (HRMs) are used by millions of athletes worldwide to monitor exercise intensity and heart rate (HR) during training. This case report presents a 34-year-old male amateur soccer player with severe bradycardia who accidentally identified numerous pauses of over 4 s (maximum length: 7.3 s) during sleep on his own HRM with a heart rate variability (HRV) function. Simultaneous HRM and Holter ECG recordings were performed in an outpatient clinic, finding consistent 6.3 s sinus arrests (SA) with bradycardia of 33 beats/min. During the patient’s hospitalization for a transient ischemic attack, the longest pauses on the Holter ECG were recorded, and he was suggested to undergo pacemaker implantation. He then reduced the volume/intensity of exercise for 4 years. Afterward, he spent 2 years without any regular training due to depression. After these 6 years, another Holter ECG test was performed in our center, not confirming the aforementioned disturbances and showing a tendency to tachycardia. The significant SA was resolved after a period of detraining. The case indicates that considering invasive therapy was unreasonable, and patient-centered care and shared decision-making play a key role in cardiac pacing therapy. In addition, some sports HRM with an HRV function can help diagnose bradyarrhythmia, both in professional and amateur athletes.

A 36-year-old professional marathon runner reported sudden heart palpitations occurring during competitions, with heart rates (HR) of 230 bpm recorded on sports HR monitor (HRM) over 4 years. These episodes subsided upon the cessation of exercise. Electrocardiograms, echocardiography, and cardiac magnetic resonance imaging results were borderline for athlete's heart. Because an electrophysiology study and standard exercise tests provoked no arrhythmia, doctors suspected Munchhausen syndrome. Ultimately, an exercise test that simulated the physical effort during a competition provoked tachyarrhythmia consistent with the HRM readings. This case demonstrates the diagnostic difficulties related to exercise-induced arrhythmia and the diagnostic usefulness of sports HRMs.