{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T23:36:28Z","timestamp":1787960188713,"version":"build-2784847793"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Ventricular arrhythmias (VAs) are a major concern in athletes. We sought to determine the prognostic role of noninvasive and invasive assessments in athletes with complex VAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>One-hundred-ninety athletes (82% men; 28 [19\u201343] years; 148 [78%] competitive athletes) with frequent or exercise-induced premature ventricular complexes or nonsustained ventricular tachycardia were included in a multicenter cohort study and categorized based on VA ECG morphology into common (n=99) and uncommon (n=91) VA groups. Each athlete underwent a comprehensive diagnostic workup, including cardiac magnetic resonance in 94% (n=178) and electrophysiology study\/electroanatomical mapping in 87% (n=166). The primary end point was the occurrence of sudden death or sustained VAs during long-term follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Athletes with uncommon VA morphology had higher rates of abnormal findings at multimodality assessment and more final diagnoses of structural heart disease. Over a median follow-up of 6.2 (4.3\u20138.1) years, 7 (4%) athletes experienced a primary outcome event, including 1 sudden death. Interestingly, no events occurred in athletes with common morphology VAs. In univariable Cox models, factors associated with the primary end point included uncommon VA morphology (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.003), lack of VA suppression (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.049), and nonsustained ventricular tachycardia\/ventricular tachycardia induction (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.010) during stress testing, late gadolinium enhancement (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.045), electroanatomical scar regions (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.022), and sustained VA inducibility by electrophysiology study (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001). Incorporating findings of invasive tests improved prediction of primary outcome events over clinical\/noninvasive findings in isolation (log-likelihood ratio for nested models,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.004). A survival tree model based on VA morphology, late gadolinium enhancement, VA response to exercise testing, and electroanatomical mapping allowed risk stratification, identifying subgroups of athletes without primary outcome events during follow-up. Among 148 competitive athletes, 101 (68%) regained eligibility after 3 months of detraining, but only 42 (28%) continued long-term.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>A comprehensive diagnostic assessment integrating ECG, stress testing, and imaging findings, along with the selective use of invasive electrophysiology assessments, may help refine the prognostic evaluation of athletes with complex VAs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circep.124.013480","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T05:00:14Z","timestamp":1748408414000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Long-Term Risk Assessment in Athletes With Complex Ventricular Arrhythmias"],"prefix":"10.1161","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1924-6548","authenticated-orcid":true,"given":"Paolo","family":"Compagnucci","sequence":"first","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy (P.C., M. Casella, G.S., F.G., A.D.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5322-1742","authenticated-orcid":true,"given":"Michela","family":"Casella","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy (P.C., M. Casella, G.S., F.G., A.D.R.)."},{"name":"Department of Clinical, Special, and Dental Sciences, Marche Polytechnic Univ, Ancona, Italy, and Maria Cecilia Hospital, GVM Care &amp; Research, Cotignola, Italy (M. Casella)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8682-0322","authenticated-orcid":true,"given":"Maria Lucia","family":"Narducci","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (M.L.N., M. Cammarano, G. Pelargonio, V.P., F.C., P.Z.)."},{"name":"Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy (M.L.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1443-5788","authenticated-orcid":true,"given":"Edoardo","family":"Conte","sequence":"additional","affiliation":[{"name":"Clinical Cardiology &amp; Cardiovascular Imaging Unit, Galeazzi-Sant\u2019Ambrogio Hospital, IRCCS, Milan, Italy (E.C., D.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Cammarano","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (M.L.N., M. Cammarano, G. Pelargonio, V.P., F.C., P.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3236-3458","authenticated-orcid":true,"given":"Gemma","family":"Pelargonio","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (M.L.N., M. Cammarano, G. Pelargonio, V.P., F.C., P.Z.)."},{"name":"Catholic Univ of the Sacred Heart, Rome, Italy (G. Pelargonio, V.P., F.C., P.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Andreini","sequence":"additional","affiliation":[{"name":"Clinical Cardiology &amp; Cardiovascular Imaging Unit, Galeazzi-Sant\u2019Ambrogio Hospital, IRCCS, Milan, Italy (E.C., D.A.)."},{"name":"University of Milan, Italy (D.A., G.V.L.R., M.B., G. Pontone, C.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Palmieri","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (M.L.N., M. Cammarano, G. Pelargonio, V.P., F.C., P.Z.)."},{"name":"Catholic Univ of the Sacred Heart, Rome, Italy (G. Pelargonio, V.P., F.C., P.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Stronati","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy (P.C., M. Casella, G.S., F.G., A.D.R.)."},{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy (G.S., F.G., A.D.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6701-0308","authenticated-orcid":true,"given":"Gerardo V.","family":"Lo Russo","sequence":"additional","affiliation":[{"name":"University of Milan, Italy (D.A., G.V.L.R., M.B., G. Pontone, C.T.)."},{"name":"Centro Cardiologico Monzino IRCCS, Milan, Italy (G.V.L.R., M.B., G. Pontone, C.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2077-2879","authenticated-orcid":true,"given":"Matteo","family":"Brusamolino","sequence":"additional","affiliation":[{"name":"University of Milan, Italy (D.A., G.V.L.R., M.B., G. Pontone, C.T.)."},{"name":"Centro Cardiologico Monzino IRCCS, Milan, Italy (G.V.L.R., M.B., G. Pontone, C.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1339-6679","authenticated-orcid":true,"given":"Gianluca","family":"Pontone","sequence":"additional","affiliation":[{"name":"University of Milan, Italy (D.A., G.V.L.R., M.B., G. Pontone, C.T.)."},{"name":"Centro Cardiologico Monzino IRCCS, Milan, Italy (G.V.L.R., M.B., G. Pontone, C.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Guerra","sequence":"additional","affiliation":[{"name":"Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy (P.C., M. Casella, G.S., F.G., A.D.R.)."},{"name":"Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy (G.S., F.G., A.D.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5487-0728","authenticated-orcid":true,"given":"Andrea","family":"Natale","sequence":"additional","affiliation":[{"name":"Texas Cardiac Arrhythmia Institute, Austin (A.N.)."},{"name":"Department of Biomedicine and Prevention, Division of Cardiology, University of Rome Tor Vergata, Italy (A.N.)."},{"name":"Department of Internal Medicine, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH (A.N.)."},{"name":"Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8500-8313","authenticated-orcid":true,"given":"Claudio","family":"Tondo","sequence":"additional","affiliation":[{"name":"University of Milan, Italy (D.A., G.V.L.R., M.B., G. 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