Arrhythmias in Athletes: New Findings Reveal Impact of Heart Health

Athletes with uncommon complex ventricular arrhythmia (VA) patterns are more likely to have structural heart disease and are at higher risk of sudden death, new study data concludes. Researchers presented these findings as an oral abstract today at Heart Rhythm 2025 in San Diego, Calif.

VAs are a diverse group of heart rhythm disorders that contribute to approximately 30% of sudden cardiac deaths worldwide, with a disproportionately higher impact on younger individuals.ⁱ Beyond their role in causing sudden death, VAs are a significant cause of morbidity, leading to debilitating symptoms that can severely affect an individual’s quality of life.

This international multicenter cohort study of 215 athletes (83% male, median age – 28 years, 162 competitive) evaluated the differences in sudden death and sustained VAs between those with common complex VAs (outflow tract/fascicular) and uncommon complex VAs (other morphologies/polymorphic). Based on results from comprehensive diagnostic evaluation—including cardiac magnetic resonance and electrophysiology study with electroanatomic mapping—researchers found that athletes with uncommon VA morphology had higher rates of abnormal findings and were more frequently diagnosed with structural heart disease.

Over a median six-year follow-up period, 16 athletes (7%) experienced sustained VAs or sudden death, with the majority of events occurring in the uncommon VA group (14 of 16, or 88%). Moreover, findings from exercise stress testing, cardiac magnetic resonance imaging, and electrophysiology study with electroanatomical mapping enabled a more refined risk stratification. Among 162 competitive athletes, 108 (67%) regained eligibility after three months, but only 44 (27%) continued playing competitively long term.

“Our study underscores the importance of comprehensive diagnostic evaluations to accurately assess the risk that uncommon complex ventricular arrhythmias pose to athletes,” said Paolo Compagnucci, M.D., Ph.D., of Marche University Hospital in Ancona, Italy. “As we continue to advance our understanding of cardiac care for athletes, it is crucial that clinicians are equipped with the knowledge and tools to manage these conditions effectively, ensuring athletes receive the care they need to return to play while safeguarding their health.”

Athletes with VAs present a challenge for physicians, often leading to uncertainties in their management.ⁱⁱ Providing proper cardiac care for athletes requires specialized knowledge of the ways in which physical activity, sport-specific factors, normal heart changes due to exercise, and arrhythmic conditions interact. In 2024, the Heart Rhythm Society released an international expert consensus statement to educate clinicians providing arrhythmia-related care to athletes, foster acceptance of the shared decision-making model for these populations, and promote research on best approaches for prevention, diagnosis, and management of arrhythmias in athletes.

The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients and is the primary information resource on heart rhythm disorders. Its mission is to improve patient care of by promoting research, education, and optimal healthcare policies and standards. Incorporated in 1979 and based in Washington, D.C., it has a membership of more than 9,000 heart rhythm professionals from 94 countries.

The Heart Rhythm Society’s annual Heart Rhythm meeting convenes 9,500 clinicians, scientists, researchers, and innovators in cardiac pacing and electrophysiology. More than 2,000 international experts serve as faculty for the 200-plus educational sessions, forums, symposia, and ceremonies, while over 110 exhibitors are showcasing products and services.

References
ⁱ Bhaskaran A, De Silva K, Kumar S. Contemporary updates on ventricular arrhythmias: from mechanisms to management. Internal Medicine Journal. 2023; 53(6):892-906.
ⁱⁱ Russo AD, Compagnucci P, Casella M, Gasperetti A, Riva S, Dessanai MA, Pizzamiglio F, Catto V, Guerra F, Stronati G, Andreini D. Ventricular arrhythmias in athletes: Role of a comprehensive diagnostic workup. Heart Rhythm. 2022; 19(1): 90-9.