Symptomatic bradyarrhythmias in the athlete-Underlying mechanisms and treatments.

Autor:	Al-Othman S; Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom., Boyett MR; Faculty of Life Sciences, University of Bradford, Bradford, United Kingdom. Electronic address: mark.richard.boyett@gmail.com., Morris GM; Cardiology Department, John Hunter Hospital, Newcastle, New South Wales, Australia., Malhotra A; Institute of Sport, Manchester Metropolitan University and Manchester University NHS Foundation Trust, Manchester, United Kingdom., Mesirca P; Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France; Laboratory of Excellence 'Ion Channel Science and Therapeutics' (ICST), Montpellier, France., Mangoni ME; Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France; Laboratory of Excellence 'Ion Channel Science and Therapeutics' (ICST), Montpellier, France., D'Souza A; Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2024 Aug; Vol. 21 (8), pp. 1415-1427. Date of Electronic Publication: 2024 Feb 28.
DOI:	10.1016/j.hrthm.2024.02.050
Abstrakt:	Bradyarrhythmias including sinus bradycardia and atrioventricular (AV) block are frequently encountered in endurance athletes especially at night. While these are well tolerated by the young athlete, there is evidence that generally from the fifth decade of life onward, such arrhythmias can degenerate into pathological symptomatic bradycardia requiring pacemaker therapy. For many years, athletic bradycardia and AV block have been attributed to high vagal tone, but work from our group has questioned this widely held assumption and demonstrated a role for intrinsic electrophysiological remodeling of the sinus node and the AV node. In this article, we argue that bradyarrhythmias in the veteran athlete arise from the cumulative effects of exercise training, the circadian rhythm and aging on the electrical activity of the nodes. We consider contemporary strategies for the treatment of symptomatic bradyarrhythmias in athletes and highlight potential therapies resulting from our evolving mechanistic understanding of this phenomenon. Competing Interests: Disclosures The authors have no conflicts to disclose. (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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