Arrhythmias and the athlete: mechanisms and clinical significance

We read with great interest the article by Ector et al. 1 reporting ventricular arrhythmias (VA) in highly trained endurance athletes, originating from a mild right ventricular (RV) dysfunction. Of note, the authors conclude that endurance exercise may act as a promoter for RV changes and a resultant trigger for VA. In part, we agree with the authors' findings; however, we have some comments regarding the postulated cause and effect relationship between RV dysfunction and VA. An increased prevalence of arrhythmias in endurance-trained athletes has been noted previously, predominantly in veteran athletes.2 Several forms of idiopathic VA have been identified in athletes, which, by definition, originate in hearts without structural abnormalities.3 Unpublished observations from our laboratory …