Higher Rate of Right Ventricle Arrhythmias in Athletes

A new study suggests that the right ventricle (RV) may be an “Achilles' heel” of the endurance athlete's heart, causing potentially fatal arrhythmias.

Researchers at St. Vincent's Hospital (Melbourne, Australia) performed exercise imaging in 17 athletes with RV ventricular arrhythmias, of which eight (47%) had an implantable cardiac defibrillator (ICD). Ten healthy endurance athletes and seven non-athletes were used as controls. Echocardiography (ECG), cardiac magnetic resonance (CMR), and invasive tracking of pulmonary and systemic artery pressures and volumes were used to measure a range of cardiac parameters at rest and during intense exercise.

The results showed that resting cardiac function was similar in all groups, as was left ventricle (LV) function during exercise. However, the researchers reported that exercise-induced increases of several RV parameters were impaired in the athletes with arrhythmias, compared with the healthy athletes and the non-athletes. In addition, the RV of athletes with RV arrhythmias acutely dilated and failed to contract adequately. The study was published on June 2, 2015, in the European Heart Journal.

“In the normal, healthy athletes, the right side of the heart was able to manage the increased work requirements. In the athletes with arrhythmias, the right side of the heart was weak during exercise, it could not handle the increase in work, and we could detect problems accurately that were not apparent at rest,” concluded lead author sports cardiologist Andre La Gerche, MD, PhD, and colleagues. “While the left ventricle remains relatively unaffected, the right ventricle has to withstand a disproportionate hemodynamic load during intense exercise, resulting in transient exercise-induced RV dysfunction and chronic RV remodeling.”

“This is of considerable clinical significance, given that routine clinical assessment of athletes with suspected arrhythmias comprises cardiac imaging at rest, often with a focus on the left ventricle,” the researchers added in a press release accompanying the study. “These results should stimulate cardiologists who manage athletes to pay greater attention to the right side of the heart. While a focus on RV measures is not commonly practiced, the measures employed in this study are relatively simple and could easily be included in clinical routine.”

Intensive regular physical training, as in competitive athletes, leads to several morphological and functional cardiac changes, with the right ventricle usually globally dilated, and the ejection fraction at rest slightly decreased. In most cases of athletes who had major ventricular arrhythmia or who died suddenly, a structural heart disease was found, more often coronary heart disease (CHD) and RV arrhythmogenic disease.

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