Halawa Bogumił
Pol Merkur Lekarski. 2004 Jan;16(91):5-7.
Cardiac arrhythmias are the reason of the most sudden deaths in athletes. The annual risk of sudden death at athletes is between 5 to 10 per one million. Benign arrhythmia including bradyarrhythmias, atrial and ventricular premature contractions are common in the athletes. Supraventricular arrhythmias such as atrial fibrillation, nodal reciprocal entrant tachycardia and Wolff-Parkinson-White syndrome are less common. Perhaps the rarest and the most dangerous arrhythmias are ventricular arrhythmias, among them arrhythmias secondary to hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, long QT syndrome, and anomalous origin of coronary arteries. Asymptomatic bradyarrhythmias (if the heart rate in bradyarrhythmia appropriate increases with exercise), supraventricularis tachycardias, and atrial premature contractions without structural heart disease are not the contraindication to sports Athletes with premature ventricular contraction, nonsustained ventricular tachycardia and non structural heart disease are without athletic restrictions as long as the arrhythmias do not worsen and they not cause dyspnea or presyncope during exertion. Frequent or multiform premature ventricular contraction or sustained ventricular tachycardia indicate a higher risk, and all participation in athletic should be restricted.
心律失常是运动员猝死的最主要原因。运动员每年猝死的风险为百万分之五至十。良性心律失常,包括缓慢性心律失常、房性和室性早搏,在运动员中很常见。室上性心律失常,如心房颤动、结性折返性心动过速和预激综合征则较少见。也许最罕见、最危险的心律失常是室性心律失常,其中继发于肥厚型心肌病、致心律失常性右室发育不良、长QT综合征和冠状动脉异常起源的心律失常。无症状性缓慢性心律失常(如果运动时缓慢性心律失常的心率适当增加)、室上性心动过速以及无结构性心脏病的房性早搏并非运动的禁忌证。有室性早搏、非持续性室性心动过速且无结构性心脏病的运动员,只要心律失常不加重且运动时不引起呼吸困难或先兆晕厥,就不受运动限制。频发或多形性室性早搏或持续性室性心动过速提示风险较高,应限制其参加所有运动。