Arrhythmogenic right ventricular remodelling in endurance athletes: Pandora´s box or Achilles´ heel?

This editorial refers to ‘Exercise-induced right ventricular dysfunction is associated with ventricular arrhythmias in endurance athletes’, by A. La Gerche et al., on page doi:10.1093/eurheartj/ehv202.

The vessel coming from the right ventricle goes into the lungs to distribute spirits necessary for their nutrition. The left ventricle … closes more tightly, because the human intelligence is born of this left part of the heart, and controls the rest of the soul …Hippocrates (460–375 BC)

The sudden death of a young athlete is a highly tragic event that has major emotional repercussions on society. Efforts to understand and prevent such catastrophes have witnessed half a century of scientific enquiry into left ventricular adaptation and disease in athletes. In contrast, the right ventricle, perceived in the early medical literature to be of little clinical consequence, has been largely neglected in sports cardiology. However, a growing number of persuasive studies have emerged in recent years to indicate that the right ventricle may hold far greater significance for the cardiac health of athletes than has been previously appreciated. Whilst it is well recognized that individuals harbouring cardiac diseases risk fatal arrhythmias during exercise,1 the idea that intense, repetitive training might promote an abnormal cardiac substrate in a previously healthy heart is relatively novel. A burgeoning body of literature has raised the possibility of irreversible cardiac remodelling, myocardial fibrosis, ventricular arrhythmias, and even sudden death in some former endurance athletes.2 This notion has been received with caution by the mainstream scientific community, perhaps driven by justifiable fears of generating an erroneous public perception that even modest exercise might be harmful. This controversial topic has become all the more …

 


Autor / Fonte:Abbas Zaidi , Sanjay Sharma DOI: http://dx.doi.org/10.1093/eurheartj/ehv199 First published online: 2 June 2015
Link: http://eurheartj.oxfordjournals.org/content/early/2015/05/26/eurheartj.ehv199