Ambulatory (24-hour Holter monitoring, event recorders) and signal-averaged ECG for arrhythmia registration in the athlete’s heart

Abstract

Systematic physical exercise leads to structural, functional, and electrical cardiovascular changes summarized in the term ‘athlete’s heart’. Arrhythmias that are common features in the resting ECG of otherwise healthy athletes may be an expression of the athlete’s heart, but on the other hand may be caused by underlying cardiac pathology, opening up a grey zone of diagnostic uncertainty. Differentiating adaptive changes from pathological cardiac conditions is of great clinical importance because some cardiomyopathies are leading causes of sudden cardiac death in athletes. In addition, there is increasing evidence that excessive endurance training may induce intermittent atrial arrhythmias, which can be hard to detect by resting ECG. Therefore this chapter will highlight 24-hour Holter monitoring, event recorders, and signal-averaged ECGs in the emerging field of ambulatory arrhythmia registration as part of the diagnostic work-up of athlete’s heart.