Exercise Patterns and Ventricular Arrhythmia in Male Endurance Athletes ≥50 Years
Overview
In a cohort of 106 male veteran endurance athletes aged 50 and older, ventricular arrhythmias occurred in 23.5% of participants and were strongly associated with myocardial fibrosis. Acute exercise exposure increased the risk of ventricular arrhythmia, whereas chronic exercise load did not influence arrhythmia incidence.
Background
Sudden cardiac death is a leading cause of mortality in older male athletes, often linked to ventricular arrhythmias. While moderate exercise is cardioprotective, intense endurance training may induce cardiac adaptations that predispose to arrhythmias. Prior studies have been limited by self-reported exercise data, but this study utilized objective exercise tracking devices and implantable loop recorders to prospectively assess the relationship between exercise patterns and ventricular arrhythmia in veteran athletes. Understanding these associations is critical to improving risk stratification and management in this population.
Data Highlights
Parameter
Value
Number of athletes
106
Median follow-up duration
796 days
Ventricular arrhythmia events
55 total (3 VT, 52 NSVT)
Athletes with ventricular arrhythmia
25 (23.5%)
Myocardial fibrosis prevalence in arrhythmia group
76.0%
Myocardial fibrosis prevalence in no arrhythmia group
Ventricular arrhythmias occurred in nearly one-quarter of veteran male endurance athletes monitored.
Myocardial fibrosis was significantly more common in athletes with ventricular arrhythmia (76%) compared to those without (38.3%).
All sustained ventricular tachycardia episodes occurred during exercise and were preceded by non-sustained ventricular tachycardia in athletes with fibrosis.
No significant differences in chronic exercise training volume, intensity, or patterns were found between athletes with and without ventricular arrhythmia.
Acute exercise exposure was associated with a higher risk of ventricular arrhythmia, whereas chronic exercise load was not.
Clinical Implications
Myocardial fibrosis may serve as a critical arrhythmogenic substrate in older male endurance athletes, particularly during acute exercise stress. Routine assessment for myocardial fibrosis could help identify athletes at increased risk of ventricular arrhythmia. Exercise prescriptions should consider the potential pro-arrhythmic effects of intense acute exercise in this population, even in the absence of differences in chronic training load.
Conclusion
In veteran male endurance athletes aged 50 and older, ventricular arrhythmias are common and strongly linked to myocardial fibrosis. Acute exercise acts as a trigger for arrhythmia in the presence of fibrosis, highlighting the need for targeted cardiac evaluation and monitoring in this group.
References
VENTOUX Study Group 2024 -- Association Between Exercise Patterns and Ventricular Arrhythmia in Male Endurance Athletes ≥50 Years
