Ventricular arrhythmias in athletes: Role of a comprehensive diagnostic workup

Antonio Dello Russo, Paolo Compagnucci, Michela Casella, Alessio Gasperetti, Stefania Riva, Maria Antonietta Dessanai, Francesca Pizzamiglio, Valentina Catto, Federico Guerra, Giulia Stronati, Daniele Andreini, Gianluca Pontone, Alice Bonomi, Stefania Rizzo, Luigi Di Biase, Alessandro Capucci, Andrea Natale, Cristina Basso, Cesare Fiorentini, Paolo ZeppilliClaudio Tondo

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: Ventricular arrhythmias (VAs) represent a critical issue with regard to sports eligibility assessment in athletes. The ideal diagnostic evaluation of competitive and leisure-time athletes with complex VAs has not been clearly defined. Objective: The purpose of this study was to assess the clinical implications of invasive electrophysiological assessments and endomyocardial biopsy (EMB) among athletes with VAs. Methods: We evaluated 227 consecutive athletes who presented to our institutions after being disqualified from participating in sports because of VAs. After noninvasive tests, electrophysiological study (EPS), electroanatomic mapping (EAM), and EAM- or cardiac magnetic resonance imaging–guided EMB was performed, following a prespecified protocol. Sports eligibility status was redefined at 6-month follow-up. Results: From our sample, 188 athletes (82.8%) underwent EAM and EPS, and 42 (15.2%) underwent EMB. A diagnosis of heart disease could be formulated in 30% of the study population (67/227; 95% confidence interval [CI] 0.24–0.36) after noninvasive tests; in 37% (83/227; 95% CI 31%–43%) after EPS and EAM; and in 45% (102/227; 95% CI 39%–51%) after EMB. In the subset of athletes undergoing EMB, invasive diagnostic workup allowed diagnostic reclassification of half of the athletes (n = 21 [50%]). Reclassification was particularly common among subjects without definitive findings after noninvasive evaluation (n = 23; 87% reclassified). History of syncope, abnormal echocardiogram, presence of late gadolinium enhancement, and abnormal EAM were linked to sports ineligibility at 6-month follow-up. Conclusion: A comprehensive invasive workup provided additional diagnostic elements and could improve the sports eligibility assessment of athletes presenting with VAs. The extensive invasive evaluation presented could be especially helpful when noninvasive tests show unclear findings.

Original languageEnglish (US)
Pages (from-to)90-99
Number of pages10
JournalHeart Rhythm
Issue number1
StatePublished - Jan 2022


  • Arrhythmogenic right ventricular cardiomyopathy
  • Athletes
  • Electroanatomic mapping
  • Endomyocardial biopsy
  • Myocarditis
  • Ventricular arrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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