Is severe bradycardia in veteran athletes an indication for a permanent pacemaker?

Northcote, Robin J.; Rankin, A C; Scullion, Richard; Logan, William D.

doi:10.1136/bmj.298.6668.231

Cited by 14 publications

(10 citation statements)

References 4 publications

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“…After lifelong physical endurance training, veteran endurance athletes have a higher incidence of sinus node disease and artificial pacemaker implantation than normal individuals567, and it is likely that this is a consequence of the marked remodelling of the sinus node shown here. It may also help explain syncope in the young athlete46.…”

Section: Discussionmentioning

confidence: 89%

“…Athletes are considered the healthiest members of society and yet, paradoxically, the incidence of arrhythmias, ranging from the benign to the pathological, is known to be higher in athletes, especially in elderly athletes with a lifelong training history 1 2 3 4 5 6 7 . Emerging data suggest that long-term training for and competing in extreme endurance events such as marathons, ultra-marathons, ironman distance triathlons and long distance bicycle races may induce pathological remodelling of the heart and potentially create a substrate for arrhythmogenesis 8 .…”

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confidence: 99%

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Exercise training reduces resting heart rate via downregulation of the funny channel HCN4

et al. 2014

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Endurance athletes exhibit sinus bradycardia, that is a slow resting heart rate, associated with a higher incidence of sinus node (pacemaker) disease and electronic pacemaker implantation. Here we show that training-induced bradycardia is not a consequence of changes in the activity of the autonomic nervous system but is caused by intrinsic electrophysiological changes in the sinus node. We demonstrate that training-induced bradycardia persists after blockade of the autonomous nervous system in vivo in mice and in vitro in the denervated sinus node. We also show that a widespread remodelling of pacemaker ion channels, notably a downregulation of HCN4 and the corresponding ionic current, If. Block of If abolishes the difference in heart rate between trained and sedentary animals in vivo and in vitro. We further observe training-induced downregulation of Tbx3 and upregulation of NRSF and miR-1 (transcriptional regulators) that explains the downregulation of HCN4. Our findings provide a molecular explanation for the potentially pathological heart rate adaptation to exercise training.

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Section: Discussionmentioning

confidence: 89%

mentioning

confidence: 99%

Exercise training reduces resting heart rate via downregulation of the funny channel HCN4

et al. 2014

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“…In our study the vast majority of blocks were Mobitz type I and all episodes of Mobitz type II block had narrow QRS complexes pointing to a proxi mal location. Long ventricular pauses induc ing syncopal attacks in athletes have been reported [7,[29][30][31], which in some cases led to pacemaker implantation [7,32], Ventricu lar pauses of up to 15 s have been recorded [22] using ambulatory monitoring. Most stud ies report a maximal pause of 3-5 s in athletes (the majority finding 3-3.5 s) and 2 s in sed entary controls, which is in agreement with our findings.…”

Section: Sinoatrial and Atrioventricular Blocksmentioning

confidence: 99%

Ambulatory Electrocardiographic Findings in Top Athletes, Athletic Students and Control Subjects

et al. 1994

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Aim of the present study was to evaluate 24 h electrocardiographic recording in 30 top athletes, 30 athletic students and 30 sedentary control subjects. Each group consisted of 15 males and 15 females and were matched for age (about 24 years). Training was not allowed during the recording. Top athletes had the lowest diurnal and nocturnal heart rate, but the difference between top athletes and athletic students was far less pronounced than between athletic students and controls. This may indicate that bradycardia reaches a lower limit with moderate degrees of training. Atrioventricular (AV) block II was found in 3 top athletes and 4 athletic students and in none of the subjects, the longest pause being 2.4 s in both athletic groups. Most episodes occurred during night and nearly all were Mobitz type I. In all cases of AV block II the QRS complexes were narrow and AV block III did not occur. SA block was found in 3 top athletes, 1 athletic student and 1 control subject, the longest pause being 3.1, 2.9 and 1.9 s, respectively. Ventricular premature beats were rare in all groups and complex ventricular arrhythmias were not found. Half of the subjects were in Lown class 0, the other half in Lown class 1. Supraventricular premature beats were also scarce and most frequent in top athletes, followed by athletic students and sedentary controls (2.0, 1.0, 0.7 beats/h, respectively).

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“…Improved symptoms on cessation of training has also been described, but in other cases a pacemaker implantation was deemed necessary [2,6], Whereas cardiac disease may coexist with training-induced bradycardia in athletes and thus induce cere bral symptoms, the underlying cause for syn copal attacks in a number of reported cases remains questionable. The aim of the present study is to analyze in depth the relation be tween training, heart rate, and conduction times.…”

Section: Introductionmentioning

confidence: 99%

Electrocardiographic Findings of Heart Rate and Conduction Times in Athletic Students and Sedentary Control Subjects

Bjørnstad¹,

Storstein²,

Meen³

et al. 1993

Cardiology

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We have investigated resting electrocardiograms in 1,299 athletic students and 151 sedentary control subjects. Bradycardia was significantly more common in athletes. The athletic group was divided according to a heart rate < 50, 50-100, and above 100 beats/min. Atrioventricular conduction time, prevalence of ectopic beats and other rhythms, parameters of right and left ventricular hypertrophy, ST elevation, and T wave amplitude were increased in the sinus bradycardia group. A significant negative correlation was found between heart rate and PQ duration in athletes. In the sinus tachycardia group, the PQ duration was shorter and the ST depression more prominent than in the other groups. The subjects were also divided according to PQ ≧ 0.22, 0.21-0.12, and < 0.12 s. Parameters of left ventricular hypertrophy were markedly increased in athletes with PQ ≧ 0.22 s, while the heart rate was only slightly decreased, suggesting an association between prolonged atrioventricular conduction time and left ventricular hypertrophy. Incomplete right bundle branch block was associated with a lower heart rate, increased duration of QRS and QTc, voltage of precordial Q waves, indices of right ventricular hypertrophy, and negative T waves. These findings are typical of right ventricular hypertrophy, indicating a close relation of incomplete right bundle branch block to right ventricular hypertrophy.

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Is severe bradycardia in veteran athletes an indication for a permanent pacemaker?

Cited by 14 publications

References 4 publications

Exercise training reduces resting heart rate via downregulation of the funny channel HCN4

Exercise training reduces resting heart rate via downregulation of the funny channel HCN4

Ambulatory Electrocardiographic Findings in Top Athletes, Athletic Students and Control Subjects

Electrocardiographic Findings of Heart Rate and Conduction Times in Athletic Students and Sedentary Control Subjects

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