Differential presentation of atrioventricular nodal re-entrant tachycardia in athletes and non-athletes

Aims Prolonged participation in exercise results in structural and electrical cardiac remodelling. The development of an athlete's heart is recognized as a risk factor for atrial arrhythmias. This study aims to evaluate the impact of athlete heart remodelling on the presentation of atrioventricular nodal re-entrant tachycardia (AVNRT). Methods and results A retrospective analysis of an ablation database selecting all patients with an electrophysiologically confirmed diagnosis of AVNRT. Athletes (individuals participating in moderate to intensive sports for 3h per week having done so for 5years) were compared with healthy non-athletes. Atrioventricular nodal re-entrant tachycardia subforms were classified according the methods described by Katritsis and Josephson in 2013 and by Heidbuchel and Jackman in 2014. A total of 504 AVNRT patients were fully characterized, of whom 85 (17%) were athletes. Almost half of the athletes presented with atypical forms of AVNRT, where in non-athletes this frequency was about 20%. There was no difference in acute procedural success among the two groups, but the procedures in athletes were more complex, as reflected by an almost two-fold increase in the use of a long sheath to reach the slow pathway ablation area and a higher recurrence rate in athletes (10% vs. 4%). Conclusion Athletes present more frequently with atypical subforms of AVNRT. This is possibly related to cardiac remodelling with dilatation of the cardiac cavities leading to changed conduction properties in the septal area. Ablation outcome is equally safe in athletes as in non-athletes with similar acute success rates. Athletes experience a higher longer-term recurrence rate.