Kampka Zofia, Drabczyk Mateusz, Piłka Nina, Orszulak Michał, Rycyk Maciej, Mizia-Stec Katarzyna, Wybraniec Maciej T
First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland.
First Department of Cardiology, Upper-Silesian Medical Center, 40-635 Katowice, Poland.
Rev Cardiovasc Med. 2024 Jun 19;25(6):221. doi: 10.31083/j.rcm2506221. eCollection 2024 Jun.
The intricate relationship between sports participation and cardiac arrhythmias is a key focus of cardiovascular research. Physical activity, integral to preventing atherosclerotic cardiovascular disease, induces structural, functional, and electrical changes in the heart, potentially triggering arrhythmias, particularly atrial fibrillation (AF). Despite the cardiovascular benefits, the optimal exercise amount remains unclear, revealing a J-shaped association between AF and exercise. Endurance athletes, particularly males, face elevated AF risks, influenced by age. Risk factors vary among sports modalities, with unique physiological responses in swim training potentially elevating AF risk. Clinical management of AF in athletes necessitates a delicate balance between rhythm control, rate control, and anticoagulation therapy. Sport-induced bradyarrhythmias, including sinus bradycardia and conduction disturbances, are prevalent among athletes. Managing bradycardia in athletes proves challenging due to its complex and not fully understood pathophysiology. Careful consideration is required, particularly in symptomatic cases, where pacemaker implantation may be necessary for sinus node dysfunction. Although pacing is recommended for specific atrioventricular (AV) blocks, milder forms often prevail without restricting sports participation. This review explores the nuanced relationship between exercise and tachy- and bradyarrhythmia in athletes, addressing the challenges clinicians face when optimizing patient care in this distinctive population.
运动参与与心律失常之间的复杂关系是心血管研究的一个关键重点。体育活动对于预防动脉粥样硬化性心血管疾病不可或缺，它会引起心脏的结构、功能和电活动变化，有可能引发心律失常，尤其是心房颤动（AF）。尽管体育活动对心血管有益，但最佳运动量仍不明确，这揭示了AF与运动之间呈J形关联。耐力运动员，尤其是男性，面临的AF风险更高，且受年龄影响。不同运动方式的风险因素各不相同，游泳训练中独特的生理反应可能会增加AF风险。运动员AF的临床管理需要在节律控制、心率控制和抗凝治疗之间微妙地平衡。运动引起的缓慢性心律失常，包括窦性心动过缓和传导障碍，在运动员中很常见。由于其病理生理学复杂且尚未完全了解，运动员缓慢性心律失常的管理颇具挑战性。需要仔细考虑，尤其是在有症状的情况下，对于窦房结功能障碍可能需要植入起搏器。虽然对于特定的房室（AV）阻滞建议进行起搏，但较轻的形式通常占主导，且不限制运动参与。本综述探讨了运动员运动与快速性和缓慢性心律失常之间的细微关系，阐述了临床医生在优化这一特殊人群的患者护理时所面临的挑战。
