Pre-excitation and conduction abnormalities

Ventricular pre-excitation (Wolff–Parkinson–White pattern) and conduction abnormalities may be discovered during cardiovascular pre-participation screening in athletes. Their prevalence varies between 0.1% (Wolff–Parkinson–White, left bundle branch block) and 1% (right bundle branch block). Patients with pre-excitation and paroxysmal palpitations need to be treated before considering their eligibility to participate in sport. An electrophysiological study is required in asymptomatic athletes with the Wolff–Parkinson–White pattern. Subjects are considered ineligible for participation in sport if the RR intervals between pre-excited complexes during induced atrial fibrillation are <250ms. Subjects with conduction abnormalities may or may not be affected by heart disease. In the absence of heart disease, athletes with first- or second-degree atrioventricular (AV) block which normalizes during effort are eligible to participate in sport. According to current Italian and US guidelines, athletes with right bundle branch block, left anterior hemiblock, left posterior hemiblock, and left bundle branch block can participate in all sports in the absence of heart disease (including genetic Lenègre disease) and no episodes of AV block.