Tachyarrhythmias in young athletes

Coelho, Aldo; Palileo, Edwin; Ashley, William W.; Swiryn, Steven; Petropoulos, A. Tom; Welch, William J.; Bauernfeind, Robert A.

doi:10.1016/s0735-1097(86)80287-x

Cited by 54 publications

(14 citation statements)

References 25 publications

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“…Five of 19 athletes evaluated for palpitations had paroxysmal AF,25 and were evaluated by resting electrocardiography, echocardiography and electrophysiological studies. Mitral valve prolapse (MVP) was reported in four athletes and WPW syndrome in one.…”

Section: Frequency Of Atrial Fibrillation In Athletesmentioning

confidence: 99%

Atrial fibrillation in endurance-trained athletes: Table 1

Sorokin

Araújo²,

Zweibel

et al. 2009

Br J Sports Med

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Section: Frequency Of Atrial Fibrillation In Athletesmentioning

confidence: 99%

Atrial fibrillation in endurance-trained athletes: Table 1

Sorokin

Araújo²,

Zweibel

et al. 2009

Br J Sports Med

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“…Although vigorous exercise has numerous health benefits, case reports and limited data suggest that male elite athletes engaging in endurance exercise that enhances parasympathetic tone, particularly jogging, may be at higher risk for the development of atrial fibrillation (AF) 1,2,3. There are limited data on the role of vigorous exercise in the development of AF among men participating in exercise at a less competitive level, where the known beneficial effects of exercise may counter balance this potential risk.…”

mentioning

confidence: 99%

Relation of Vigorous Exercise to Risk of Atrial Fibrillation

Aizer

Gaziano

Cook

et al. 2009

The American Journal of Cardiology

327

217

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Limited data suggest that athletes may have a higher risk of developing atrial fibrillation (AF); however there has been no large prospective assessment of the relationship between vigorous exercise and AF. Logistic regression analyses stratified by time were utilized to assess the association between frequency of vigorous exercise and risk of developing AF among 16,921 apparently healthy men in the Physicians' Health Study. During 12 years of follow-up, 1,661 men reported developing AF. With increasing frequency of vigorous exercise (0, <1, 1−2, 3−4, 5−7 days per week), the multivariate relative risks for the full cohort were 1.0 (referent), 0.90, 1.09, 1.04, 1.20 (p=0.04). This risk was not significantly elevated when exercise habits were updated or in models excluding variables that may be in the biologic pathway through which exercise influences AF risk. In sub-group analyses, this elevated risk was observed only in men below age 50 [1.0, 0.94, 1.20, 1.05, 1.74 (p<0.01)] and joggers [1.0, 0.91, 1.03, 1.30, 1.53 (p<0.01)], where risks remained elevated in all analyses. In conclusion, frequency of vigorous exercise was associated with an increased risk of developing AF among young men and joggers. This risk diminished as the population aged and was offset by known beneficial effects of vigorous exercise on other AF risk factors. KeywordsAtrial fibrillation; exercise; arrhythmia Although vigorous exercise has numerous health benefits, case reports and limited data suggest that male elite athletes engaging in endurance exercise that enhances parasympathetic tone, particularly jogging, may be at higher risk for the development of atrial fibrillation (AF). 1,2, 3 There are limited data on the role of vigorous exercise in the development of AF among men participating in exercise at a less competitive level, where the known beneficial effects of exercise may counter balance this potential risk. We hypothesized that young men in whom parasympathetic tone is most pronounced may be at highest risk of developing AF. To further define the risks and benefits of exercise on AF risk, we prospectively examined the relationship between amount and type of vigorous exercise and subsequent development of AF among men in the Physicians' Health Study. MethodsThe methods of the Physicians' Health Study have been described in detail elsewhere. 4 The study complies with the Declaration of Helsinki, was approved by the Institutional Review Board of Brigham and Women's Hospital and the participants gave informed consent. Briefly, 22,071 male physicians 40 − 84 years old in 1982 with no history of myocardial infarction, stroke, transient ischemic attacks, or cancer were randomized to aspirin and/or beta-carotene using a double-blind, placebo-controlled, two-by-two factorial design. Information on health status, risk factors for cardiovascular disease and AF, along with dietary and lifestyle factors was collected via questionnaires. Participants who failed to complete the 3-year follow-up questionnaire regarding exercise habits (...

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“…Thirdly, a treadmill or ergometer exercise test provoked supraventricular tachycardia in only one patient. This low rate of provocation of tachycardia with an exercise test might be because exercise was not as strenuous as that reported by Coelho et al 6 Finally, the mechanism of palpitation in patient 8 remained uncertain. We should have tested a higher dose of isoprenaline infusion.…”

Section: Limitationsmentioning

confidence: 73%

“…Electrophysiological data on cases of exercise related supraventricular tachycardia are limited.68 Coelho et al reported that four of five cases of exercise related supraventricular tachycardia had an atrioventricular accessory pathway and atrioventricular reentrant tachycardia.6 Shortening of the atrioventricular nodal refractory period by isoprenaline and atropine was necessary to sustain supraventricular tachycardia in one and two cases respectively.6 In two of five patients in Coelho et al's study supraventricular tachycardia occurred only during treadmill exercise at a high level. 6 Akhtar et al reported on five cases of atrioventricular nodal reentrant tachycardia induced only by programmed stimulation after atropine injection." In three of five cases, the anterograde limb of the atrioventricular nodal reentrant pathway was refractory to the reciprocating impulse in the control state and atropine was required to reduce the refractory period of the atrioventricular node sufficiently to permit continuous reciprocation.…”

Section: Discussionmentioning

confidence: 99%

Electrophysiological study of young patients with exercise related paroxysms of palpitation: role of atropine and isoprenaline for initiation of supraventricular tachycardia.

Toda

Kawahara

Murakawa

et al. 1989

Heart

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SUMMARY Electrophysiological studies were performed in eight patients (four men and four women, mean (SD) age 24 (5) years with paroxysmal attacks of palpitation during or immediately after exercise. Five patients were competitive athletes at college. In two patients spontaneous supraventricular tachycardia during exercise was recorded by ambulatory electrocardiographic monitoring and in another it was induced by treadmill exercise testing. Two had dual atrioventricular nodal pathways, three had manifest atrioventricular accessory pathways, and three had concealed atrioventricular pathways. Programmed stimulation induced sustained supraventricular tachycardia in six patients-in two after intravenous injection of atropine sulphate (1 mg) and in four during infusion of isoprenaline (0-01 gg/kg/min). In one patient, non-sustained atrioventricular nodal reentrant tachycardia was induced during isoprenaline infusion. In the remaining patient, who had dual atrioventricular nodal pathways, tachycardia was not inducible. AH block prevented maintenance of reentry in five patients. In five patients shortening of the effective refractory period of the atrioventricular node with atropine (one patient) and isoprenaline (four patients) caused sustained supraventricular tachycardia.The present study indicates that treatment with atropine and isoprenaline may be an important factor in the initiation of supraventricular tachycardia in patients with exercise related paroxysms of palpitation.

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Tachyarrhythmias in young athletes

Cited by 54 publications

References 25 publications

Atrial fibrillation in endurance-trained athletes: Table 1

Atrial fibrillation in endurance-trained athletes: Table 1

Relation of Vigorous Exercise to Risk of Atrial Fibrillation

Electrophysiological study of young patients with exercise related paroxysms of palpitation: role of atropine and isoprenaline for initiation of supraventricular tachycardia.

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