| Abstract [eng] |
Background: One of the most effective strategies for cardiovascular disease prevention is regular physical activity. But chronic high intensive endurance training may increase the risk of different cardiac arrythmias. This is demonstrated by several recent studies. Aim: This systematic literature review identifies and evaluates the current evidence on arrhythmias in endurance athletes, focusing on their epidemiology, clinical characteristics, and management strategies. Methods: Four databases (PubMed, ScienceDirect, Google Scholar, and Scopus) were screened according to the PRISMA 2020 guidelines for primary studies published between 2016 and 2026. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Due to the heterogeneity of the primary studies identified, a narrative synthesis was conducted. Results: A total of 33 studies were included, involving more than millions of participants. Across all studies, atrial fibrillation was the most common arrhythmia. The prevalence was ranging from 0.3% in young elite athletes to over 30% in former athletes. This suggests a U-shaped dose-response relationship with cumulative training volume. Both men and women were affected and have a significantly increased risk. For ventricular arrhythmias, the strongest predictor was non-ischemic myocardial fibrosis, accounting for 48% in former athletes. Bradyarrhythmias were also common, though they are typically benign. In therapeutic relevant bradyarrhythmia, former athletes often require a pacemaker earlier than the general population. The survival rate from sudden cardiac arrest has doubled in recent decades due to improved emergency response. Athletes with supraventricular tachycardias exhibited specific electrophysiological characteristics and more frequent recurrences following ablation. Left atrial enlargement persisted after cessation of training, suggesting irreversible remodeling. Catheter ablations were effective for both supraventricular and ventricular arrhythmias despite higher recurrence rates. Anticoagulation therapy for atrial fibrillation was used less frequently than in the general population. Conclusion: Arrhythmias in endurance athletes encompass a broad spectrum with specific epidemiological and clinical characteristics, as well as management strategies. A shared decision-making process adapted to the individual athlete is recommended. Critical gaps in the research remain regarding female athletes, genetic predisposition, the long-term natural course of training-induced cardiac remodeling, and optimal treatment strategies. |
