{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T07:48:04Z","timestamp":1768981684661,"version":"3.49.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Ventricular ectopic beats (VEBs) are frequently observed in athletes, but their clinical significance remains debated. We aimed to assess the prevalence, pattern of exercise-induced VEBs, and their association with exercise-induced cardiac remodeling (EICR) in elite athletes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We analyzed a large cohort of Olympic athletes who underwent comprehensive preparticipation screening, including exercise-electrocardiography test and echocardiography. VEB morphology was classified as common (left bundle branch block, with inferior axis, and fascicular) or uncommon, including polymorphic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      We enrolled 2525 athletes (mean age, 25.7\u00b15.2 years; 45.1% women); 14.8% of athletes had exercise-induced VEBs, more frequently men (16.7% versus 12.4%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.002), with no differences between sport disciplines (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.295). The VEB pattern was defined in 283 (ie, 76%), including 135 (48%) common and 148 (52%) uncommon, including polymorphic. Prevalence of common VEBs increased proportionally with the functional capacity (as W\/kg), ranging from 16.3.% in I quartile to 40% in IV quartile (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.0001), while no differences existed in those with uncommon VEBs (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.140). Moreover, athletes with common VEBs showed a greater EICR, including a larger right ventricle (with wider right ventricular outflow tract;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.014; right ventricular end-diastolic area;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.016) and left ventricle (greater left ventricular mass indexed;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.037; a higher prevalence of eccentric remodeling;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.019). On the contrary, no relationship with cardiac remodeling or exercise capacity was seen in athletes with uncommon VEBs and in those without VEBs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Exercise-induced common VEBs in athletes seem to be associated with EICR and superior exercise performance and may represent a benign phenomenon, expression of the pathophysiologic consequences of EICR. Instead, uncommon VEBs were not related to the extent of EICR or the level of exercise performance, suggesting a nonphysiological nature.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circep.125.014143","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T10:00:16Z","timestamp":1766397616000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Athlete\u2019s Heart or Heart at Risk? Cardiac Remodeling and Exercise-Induced Ventricular Arrhythmias in Elite Athletes"],"prefix":"10.1161","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9158-5440","authenticated-orcid":true,"given":"Giuseppe","family":"Di Gioia","sequence":"first","affiliation":[{"name":"Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome (G.D.G., M.R.S., A.F., F.R.S., V.M., S.M., F.M., G.P., A.S., A.P.)."},{"name":"Department of Movement, Human and Health Sciences, University of Rome \u201cForo Italico\u201d (G.D.G.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8935-9366","authenticated-orcid":true,"given":"Maria Rosaria","family":"Squeo","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome (G.D.G., M.R.S., A.F., F.R.S., V.M., S.M., F.M., G.P., A.S., A.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7291-2450","authenticated-orcid":true,"given":"Armando","family":"Ferrera","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome (G.D.G., M.R.S., A.F., F.R.S., V.M., S.M., F.M., G.P., A.S., A.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1640-9428","authenticated-orcid":true,"given":"Francesco Raffaele","family":"Spera","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome (G.D.G., M.R.S., A.F., F.R.S., V.M., S.M., F.M., G.P., A.S., A.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3225-8378","authenticated-orcid":true,"given":"Viviana","family":"Maestrini","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome (G.D.G., M.R.S., A.F., F.R.S., V.M., S.M., F.M., G.P., A.S., A.P.)."},{"name":"Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences (V.M., S.M.), Sapienza University of Rome, Italy."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5960-7980","authenticated-orcid":true,"given":"Sara","family":"Monosilio","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome (G.D.G., M.R.S., A.F., F.R.S., V.M., S.M., F.M., G.P., A.S., A.P.)."},{"name":"Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences (V.M., S.M.), Sapienza University of Rome, Italy."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5895-9191","authenticated-orcid":true,"given":"Federica","family":"Mango","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome (G.D.G., M.R.S., A.F., F.R.S., V.M., S.M., F.M., G.P., A.S., A.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8729-1394","authenticated-orcid":true,"given":"Giulia","family":"Paoletti","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome (G.D.G., M.R.S., A.F., F.R.S., V.M., S.M., F.M., G.P., A.S., A.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8155-9774","authenticated-orcid":true,"given":"Andrea","family":"Serdoz","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome (G.D.G., M.R.S., A.F., F.R.S., V.M., S.M., F.M., G.P., A.S., A.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1593-475X","authenticated-orcid":true,"given":"Marco","family":"Bernardi","sequence":"additional","affiliation":[{"name":"Department of Physiology and Pharmacology \u201cV. Erspamer\u201d (M.B.), Sapienza University of Rome, Italy."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4174-3401","authenticated-orcid":true,"given":"Antonio","family":"Pelliccia","sequence":"additional","affiliation":[{"name":"Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome (G.D.G., M.R.S., A.F., F.R.S., V.M., S.M., F.M., G.P., A.S., A.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/heart.89.12.1455"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-130-1-199901050-00005"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(94)90439-1"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.09.013"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.613562"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-097331"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcdd11100303"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae666.3010"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euae279"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwac224"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/sms.12679"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2023.131220"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0735-1097(02)01977-0"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/hjh.0000000000003936"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2021.02.021"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2018-100529"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa605"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198710223171717"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae178"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2016.04.020"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx532"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.10.003"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2016.01.011"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.120.011587"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euad255"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.009171"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(85)90075-4"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2014.09.009"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.05.065"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac262"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.116.004229"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.23736\/S0026-4806.24.09519-3"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.125.013807"}],"container-title":["Circulation: Arrhythmia and Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCEP.125.014143","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T19:00:38Z","timestamp":1768935638000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCEP.125.014143"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1161\/CIRCEP.125.014143"],"URL":"https:\/\/doi.org\/10.1161\/circep.125.014143","relation":{},"ISSN":["1941-3149","1941-3084"],"issn-type":[{"value":"1941-3149","type":"print"},{"value":"1941-3084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-06-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}