Amateur Athlete with Sinus Arrest and Severe Bradycardia Diagnosed through a Heart Rate Monitor: A Six-Year Observation—The Necessity of Shared Decision-Making in Heart Rhythm Therapy Management

Abstract

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.

Sports Heart Monitors as Reliable Diagnostic Tools for Training Control and Detecting Arrhythmias in Professional and Leisure-Time Endurance Athletes: An Expert Consensus Statement

“…In any case, the athlete must sleep with an HRM (with at least a PPG sensor) or with a monitor or transmitter, typically worn in the form of a chest strap. In both cases, the transmitted data are collected by a receiver, such as a smartwatch or a smartphone lying at the bedside [ 66 ]. Frequent deconditioning is the main remedy for symptom resolution.…”

Exercise-Induced Arrhythmia or Munchausen Syndrome in a Marathon Runner?

“…Some of the sports HRM measurements were tested and compared with a Holter ECG. A team of doctors and technicians with extensive experience in the analysis of HRM measurements used by athletes of various disciplines training under different conditions [16][17][18] analyzed the results.…”