I'm a bit confused by this article. It zeros in on ventricular arrhythmias in endurance athletes. Yet ventricular arrhythmias (Vtachycardia, Vfib, pvcs, etc) are much less common (by 5x to 10x less common) than atrial arrhythmias (Afib, Aflutter, pacs, svt/avnrt, etc). If a reader of this article did not know this, they might think that ventricular arrhythmias are one of the leading afflictions of endurance athletes. They are not. While this summary of V arrhythmias in athletes might be correct, it does not clearly state that the much bigger problem in endurance athletes is with atrial arrhythmias (I'm in this group). And, respectfully, since this was not stated, it left me wondering if the author even knows the difference between V arrhythmias and A arrhythmias. Hence my confusion.
Great post. The distinction between training load and underlying risk factors was helpful. A nice counter to the “too much exercise is bad” oversimplification.
Great article! We often do hear about endurance athletes and the risk of dysrhythmias, but there's not much tangible advice on how to lower risk. So, this is a great summary to show that essentially how we train may not actually be related to risk.
The idea that pre-existing myocardial fibrosis seems to be the major risk makes sense. Now, the question is what caused that fibrosis in the first place and how can all athletes avoid that? Is it a cumulative history of long exercise sessions? Extreme interval training? A history of exercising while having a subclinical myocarditis? Previous history of subclinical myocarditis (regardless of exercise)? Or just genetic predisposition?
Thanks for the follow-up article - it addresses the question I was about to ask… as an over-60 long-term high-volume runner, should I be asking my cardiologist for an MRI to look for ventricular fibrosis. Apparently it’s not that simple.
I'm glad to see this, since I am 59 and registered for the Trans Am Bike Race this year. 20+ days of riding 14+ hours counts as high-volume I think :). Luckily, I have only experienced Afib in the past when training at high intensity when I was trying to hit marathon PRs, and never from high volume 'zone 2' cycling or running.
I'm a bit confused by this article. It zeros in on ventricular arrhythmias in endurance athletes. Yet ventricular arrhythmias (Vtachycardia, Vfib, pvcs, etc) are much less common (by 5x to 10x less common) than atrial arrhythmias (Afib, Aflutter, pacs, svt/avnrt, etc). If a reader of this article did not know this, they might think that ventricular arrhythmias are one of the leading afflictions of endurance athletes. They are not. While this summary of V arrhythmias in athletes might be correct, it does not clearly state that the much bigger problem in endurance athletes is with atrial arrhythmias (I'm in this group). And, respectfully, since this was not stated, it left me wondering if the author even knows the difference between V arrhythmias and A arrhythmias. Hence my confusion.
Great post. The distinction between training load and underlying risk factors was helpful. A nice counter to the “too much exercise is bad” oversimplification.
Great article! We often do hear about endurance athletes and the risk of dysrhythmias, but there's not much tangible advice on how to lower risk. So, this is a great summary to show that essentially how we train may not actually be related to risk.
The idea that pre-existing myocardial fibrosis seems to be the major risk makes sense. Now, the question is what caused that fibrosis in the first place and how can all athletes avoid that? Is it a cumulative history of long exercise sessions? Extreme interval training? A history of exercising while having a subclinical myocarditis? Previous history of subclinical myocarditis (regardless of exercise)? Or just genetic predisposition?
All valid questions that we don’t have the answers to yet?
I wrote a follow-up expanding on your analysis here — especially on the screening blind spot for athletes. Thanks for surfacing the paper.
https://open.substack.com/pub/jameslombardo/p/the-blind-spot-in-athlete-heart-screening?r=2d6tw0&utm_medium=ios&shareImageVariant=overlay
Thanks for the follow-up article - it addresses the question I was about to ask… as an over-60 long-term high-volume runner, should I be asking my cardiologist for an MRI to look for ventricular fibrosis. Apparently it’s not that simple.
Good enough to ReRead this AM!
I'm glad to see this, since I am 59 and registered for the Trans Am Bike Race this year. 20+ days of riding 14+ hours counts as high-volume I think :). Luckily, I have only experienced Afib in the past when training at high intensity when I was trying to hit marathon PRs, and never from high volume 'zone 2' cycling or running.