Ventricular arrhythmias recorded on 12-lead ambulatory electrocardiogram monitoring in healthy volunteer athletes and controls: what is common and what is not

Abstract

Aims: Premature ventricular beats (PVBs) in athletes are often benign, but sometimes they may be a sign of an underlying disease. We evaluated the prevalence, burden, and morphology of PVBs in healthy voluntary athletes and controls with the main purpose of defining if certain PVB patterns are 'common' and 'training related' and, as such, are more likely benign.

Methods and results: We studied 433 healthy competitive athletes [median age 27 (18-43) years, 74% males] and 261 age- and sex-matched sedentary subjects who volunteered to undergo 12-lead 24 h ambulatory electrocardiogram (ECG) monitoring (24H ECG), with a training session in athletes. Ventricular arrhythmias (VAs) were evaluated in terms of their number, complexity [i.e. couplet, triplet, or non-sustained ventricular tachycardia (NSVT)], exercise inducibility, and morphology. Eighty-six percent of athletes and controls exhibited a total of ≤10 PVBs/24 h, and >90% did not show any couplets, triplets, or runs of NSVT > 3 beats. An higher number of PVBs correlated with increasing age (P < 0.01) but not with sex and level of training. The most frequent morphologies among the 36 athletes with >50 PVBs were the infundibular (44%) and fascicular (22%) ones. In a comparison between athletes and sedentary individuals, and male and female athletes, no statistically significant differences were found in PVBs morphologies.

Conclusion: The prevalence and complexity of VAs at 24H ECG did not differ between athletes and sedentary controls and were not related to the type and amount of sport or sex. Age was the only variable associated with an increased PVB burden. Thus, no PVB pattern in the athlete can be considered 'common' or 'training related'.

Keywords: Pre-participation screening; Premature ventricular beats; Sports cardiology; Sudden cardiac death; Ventricular arrhythmias.

Graphical Abstract

The study enrolled 433 athletes and 261 sedentary subjects who underwent 12-lead 24H ECG. Premature ventricular beats were found to be rare in athletes and sedentary subjects, with infundibular and fascicular morphologies being the most common; their incidence and morphologies were not related to the type and amount of sport, nor to sex, and tended to increase with age. 12-lead 24H ECG, 12-lead 24 h electrocardiogram monitoring; PVBs, premature ventricular beats.

Figure 1

Grading of VAs in 24 h ambulatory ECG monitoring in athletes and age- and sex-matched sedentary controls. NSVT, non-sustained ventricular tachycardia; PVBs, premature ventricular beats; VAs, ventricular arrhythmias.

Figure 2

Grading of VAs on 24 h ambulatory ECG monitoring in male and female athletes. NSVT, non-sustained ventricular tachycardia; PVBs, premature ventricular beats; VAs, ventricular arrhythmias.

Figure 3

Grading of VAs in 24 h ambulatory ECG monitoring in higher training volume and lower training volume groups. NSVT, non-sustained ventricular tachycardia; PVBs, premature ventricular beats; VAs, ventricular arrhythmias.

Figure 4

Number of PVBs in athletes divided into four age groups (16–20 years old, 21–30 years old, 31–40 years old, and >40 years old). PVBs, premature ventricular beats.

Figure 5

Prevalent morphologies of ventricular arrhythmias among 36 athletes and 20 sedentary controls with >50 isolated PVBs. LBBB, left bundle branch block; PVBs, premature ventricular beats; RBBB, right bundle branch block.

Figure 6

Prevalent morphologies of ventricular arrhythmias among female and male athletes with >50 isolated PVBs. LBBB, left bundle branch block; PVBs, premature ventricular beats; RBBB, right bundle branch block.