{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T21:03:29Z","timestamp":1769115809857,"version":"3.49.0"},"reference-count":44,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,2,26]],"date-time":"2021-02-26T00:00:00Z","timestamp":1614297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>A recent surveillance analysis indicates that cardiac arrest\/death occurs in \u22481:50,000 professional or semi-professional athletes, and the most common cause is attributable to life-threatening ventricular arrhythmias (VAs). It is critically important to diagnose any inherited\/acquired cardiac disease, including coronary artery disease, since it frequently represents the arrhythmogenic substrate in a substantial part of the athletes presenting with major VAs. New insights indicate that athletes develop a specific electro-anatomical remodeling, with peculiar anatomic distribution and VAs patterns. However, because of the scarcity of clinical data concerning the natural history of VAs in sports performers, there are no dedicated recommendations for VA ablation. The treatment remains at the mercy of several individual factors, including the type of VA, the athlete\u2019s age, and the operator\u2019s expertise. With the present review, we aimed to illustrate the prevalence, electrocardiographic (ECG) features, and imaging correlations of the most common VAs in athletes, focusing on etiology, outcomes, and sports eligibility after catheter ablation.<\/jats:p>","DOI":"10.3390\/medicina57030205","type":"journal-article","created":{"date-parts":[[2021,2,26]],"date-time":"2021-02-26T06:47:20Z","timestamp":1614322040000},"page":"205","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes"],"prefix":"10.3390","volume":"57","author":[{"given":"Nicola","family":"Tarantino","sequence":"first","affiliation":[{"name":"Arrhythmia Service, Department of Medicine, Division of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3837-3462","authenticated-orcid":false,"given":"Domenico","family":"Della Rocca","sequence":"additional","affiliation":[{"name":"St. David\u2019s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"De Leon De La Cruz","sequence":"additional","affiliation":[{"name":"Brookdale University Hospital Medical Center, Brooklyn, NY 11212 USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Manheimer","sequence":"additional","affiliation":[{"name":"Arrhythmia Service, Department of Medicine, Division of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9883-0114","authenticated-orcid":false,"given":"Michele","family":"Magnocavallo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular\/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Lavalle","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular\/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences, Policlinico Umberto I, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carola","family":"Gianni","sequence":"additional","affiliation":[{"name":"St. David\u2019s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanghamitra","family":"Mohanty","sequence":"additional","affiliation":[{"name":"St. David\u2019s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chintan","family":"Trivedi","sequence":"additional","affiliation":[{"name":"St. David\u2019s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amin","family":"Al-Ahmad","sequence":"additional","affiliation":[{"name":"St. David\u2019s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodney","family":"Horton","sequence":"additional","affiliation":[{"name":"St. David\u2019s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Bassiouny","sequence":"additional","affiliation":[{"name":"St. David\u2019s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Burkhardt","sequence":"additional","affiliation":[{"name":"St. David\u2019s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Gallinghouse","sequence":"additional","affiliation":[{"name":"St. David\u2019s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8895-8915","authenticated-orcid":false,"given":"Giovanni","family":"Forleo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Azienda Ospedaliera-Universitaria \u201cLuigi Sacco\u201d, 20057 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Di Biase","sequence":"additional","affiliation":[{"name":"Arrhythmia Service, Department of Medicine, Division of Cardiology, Montefiore Medical Center, Bronx, NY 10467, USA"},{"name":"Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Natale","sequence":"additional","affiliation":[{"name":"St. David\u2019s Medical Center, Texas Cardiac Arrhythmia Institute, 3000 N. IH-35, Suite 720, Austin, TX 78705, USA"},{"name":"Interventional Electrophysiology, Scripps Clinic, La Jolla, CA 92037, USA"},{"name":"Department of Cardiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Peterson, D.F., Kucera, K., Thomas, L.C., Maleszewski, J., Siebert, D., Lopez-Anderson, M., Zigman, M., Schattenkerk, J., Harmon, K.G., and Drezner, J.A. (2020). Aetiology and incidence of sudden cardiac arrest and death in young competitive athletes in the USA: A 4-year prospective study. Br. J. Sports Med.","DOI":"10.1136\/bjsports-2020-102666"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.ccep.2019.02.007","article-title":"The Value of Baseline and Arrhythmic ECG in the Interpretation of Arrhythmic Mechanisms","volume":"11","author":"Chen","year":"2019","journal-title":"Card. Electrophysiol. Clin."},{"key":"ref_3","first-page":"1401","article-title":"The athlete\u2019s heart is a proarrhythmic heart, and what that means for clinical decision making","volume":"20","author":"Heidbuchel","year":"2018","journal-title":"Ep Eur."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1097\/CRD.0000000000000040","article-title":"Novel Perspectives on Arrhythmia-Induced Cardiomyopathy: Pathophysiology, Clinical Manifestations and an Update on Invasive Management Strategies","volume":"23","author":"Santini","year":"2015","journal-title":"Cardiol. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ijcard.2017.10.012","article-title":"\u201cPAFIYAMA\u201d syndrome; further evidence on a novel clinical entity","volume":"256","author":"Brunetti","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.ijcard.2017.10.073","article-title":"PAFIYAMA syndrome evidence in highly trained population","volume":"256","author":"Lippi","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.jacc.2016.11.041","article-title":"Isolated Subepicardial Right Ventricular Outflow Tract Scar in Athletes With Ventricular Tachycardia","volume":"69","author":"Venlet","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"256","DOI":"10.15420\/aer.2018.56.2","article-title":"Percutaneous Treatment of Non-paroxysmal Atrial Fibrillation: A Paradigm Shift from Pulmonary Vein to Non-pulmonary Vein Trigger Ablation?","volume":"7","author":"Mohanty","year":"2018","journal-title":"Arrhythm. Electrophysiol. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/S0735-1097(02)01977-0","article-title":"Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes","volume":"40","author":"Biffi","year":"2002","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","first-page":"676","article-title":"Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part 2: Ventricular arrhythmias, channelopathies, and implantable defibrillators","volume":"13","author":"Heidbuchel","year":"2020","journal-title":"EP Eur."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.ccep.2018.02.006","article-title":"Localization of Ventricular Arrhythmias for Catheter Ablation","volume":"10","author":"Gianni","year":"2018","journal-title":"Card. Electrophysiol. Clin."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.ccep.2018.02.013","article-title":"Ectopic Beats","volume":"10","author":"Bagliani","year":"2018","journal-title":"Card. Electrophysiol. Clin."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S307","DOI":"10.21037\/jtd.2019.01.11","article-title":"Role of surface electrocardiogram in the era of high-resolution mapping and imaging systems\u2014back to the future","volume":"11","author":"Lavalle","year":"2019","journal-title":"J. Thorac. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.hrthm.2019.09.010","article-title":"Association of fragmented QRS with left atrial scarring in patients with persistent atrial fibrillation undergoing radiofrequency catheter ablation","volume":"17","author":"Canpolat","year":"2020","journal-title":"Heart Rhythm"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"725","DOI":"10.2217\/fca-2020-0035","article-title":"Implantable loop recorders for cardiac dysrhythmia monitoring","volume":"16","author":"Akella","year":"2020","journal-title":"Future Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1111\/j.1540-8159.2006.00367.x","article-title":"T-Wave Oversensing by an Implantable Cardioverter Defibrillator after Successful Ablation of Idiopathic Ventricular Fibrillation","volume":"29","author":"Strohmer","year":"2006","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s10840-019-00617-9","article-title":"Electrocardiographic features, mapping and ablation of idiopathic outflow tract ventricular arrhythmias","volume":"57","author":"Lavalle","year":"2020","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1007\/s10840-019-00631-x","article-title":"Feasibility of automated detection of sleep apnea using implantable pacemakers and defibrillators: A comparison with simultaneous polysomnography recording","volume":"56","author":"Albanese","year":"2019","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"779","DOI":"10.2459\/JCM.0b013e32834ae458","article-title":"Predictive value of fragmented QRS in primary prevention implantable cardioverter defibrillator recipients with left ventricular dysfunction","volume":"12","author":"Forleo","year":"2011","journal-title":"J. Cardiovasc. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1016\/j.hrthm.2011.07.021","article-title":"Concealed cardiomyopathies in competitive athletes with ventricular arrhythmias and an apparently normal heart: Role of cardiac electroanatomical mapping and biopsy","volume":"8","author":"Pieroni","year":"2011","journal-title":"Heart Rhythm"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1016\/S0195-668X(03)00282-3","article-title":"High prevalence of right ventricular involvementin endurance athletes with ventricular arrhythmias Role of an electrophysiologic study in risk stratification","volume":"24","year":"2003","journal-title":"Eur. Heart J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e009171","DOI":"10.1161\/JAHA.118.009171","article-title":"Ventricular Arrhythmias in Young Competitive Athletes: Prevalence, Determinants, and Underlying Substrate","volume":"7","author":"Zorzi","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1161\/CIRCULATIONAHA.120.046900","article-title":"Diagnostic Yield of Electroanatomic Voltage Mapping in Guiding Endomyocardial Biopsies","volume":"142","author":"Casella","year":"2020","journal-title":"Circulation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1111\/echo.14767","article-title":"On the role of echocardiography and beta-receptors downregulation in multipattern Takotsubo","volume":"37","author":"Tarantino","year":"2020","journal-title":"Echocardiography"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.ccep.2020.06.004","article-title":"Epicardial Ablation Complications","volume":"12","author":"Tarantino","year":"2020","journal-title":"Card. Electrophysiol. Clin."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ccep.2019.11.004","article-title":"Role of the Left Atrial Appendage in Systemic Homeostasis, Arrhythmogenesis, and Beyond","volume":"12","author":"Murtaza","year":"2020","journal-title":"Card. Electrophysiol. Clin."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"796","DOI":"10.2459\/JCM.0b013e328361d1c7","article-title":"Arrhythmogenic right-ventricular cardiomyopathy and cardiac microvascular disease: A rare association or a possible link?","volume":"18","author":"Forleo","year":"2017","journal-title":"J. Cardiovasc. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1001\/jama.1996.03540030033028","article-title":"Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles","volume":"276","author":"Maron","year":"1996","journal-title":"JAMA"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/ehjcr\/ytaa016","article-title":"Do athletes play by different rules? Obstructive coronary artery disease in asymptomatic competitive Masters athletes: A case series","volume":"4","author":"McKinney","year":"2020","journal-title":"Eur. Heart J. Case Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1161\/CIRCULATIONAHA.116.026964","article-title":"Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes With a Low Atherosclerotic Risk Profile","volume":"136","author":"Merghani","year":"2017","journal-title":"Circulation"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1007\/s00380-013-0455-6","article-title":"Ventricular arrhythmias induced by long-term use of ephedrine in two competitive athletes","volume":"30","author":"Casella","year":"2015","journal-title":"Heart Vessel."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2793","DOI":"10.1093\/eurheartj\/ehv316","article-title":"2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC)","volume":"36","author":"Priori","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e73","DOI":"10.1016\/j.hrthm.2017.10.036","article-title":"2017 AHA\/ACC\/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death","volume":"15","author":"Stevenson","year":"2018","journal-title":"Heart Rhythm"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Brice\u00f1o, D.F., Romero, J., Patel, K., Liaqat, W., Zhang, X.-D., Alviz, I., Yang, R., Rodriguez, D., Lakkireddy, D., and Rocca, D.D. (2020). First-line ablation of ventricular tachycardia in ischemic cardiomyopathy: Stratification of outcomes by left ventricular function. J. Interv. Card. Electrophysiol.","DOI":"10.22541\/au.159363450.06532059"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1016\/j.hrthm.2019.01.005","article-title":"Ablation Index as a predictor of long-term efficacy in premature ventricular complex ablation: A regional target value analysis","volume":"16","author":"Casella","year":"2019","journal-title":"Heart Rhythm"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.1111\/jce.14593","article-title":"Endo-epicardial ablation vs endocardial ablation for the management of ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy: A systematic review and meta-analysis","volume":"31","author":"Romero","year":"2020","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_37","first-page":"104","article-title":"Long-term outcomes of different ablation strategies for ventricular tachycardia in patients with structural heart disease: Systematic review and meta-analysis","volume":"20","author":"Romero","year":"2018","journal-title":"Ep Eur."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.hrthm.2018.11.028","article-title":"Variant of ventricular outflow tract ventricular arrhythmias requiring ablation from multiple sites: Intramural origin","volume":"16","author":"Romero","year":"2019","journal-title":"Heart Rhythm"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e010365","DOI":"10.1161\/JAHA.118.010365","article-title":"Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy\/Dysplasia: A Sequential Approach","volume":"8","author":"Mathew","year":"2019","journal-title":"JAHA"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1161\/CIRCEP.111.963066","article-title":"Ablation of Ventricular Arrhythmias in Arrhythmogenic Right Ventricular Dysplasia\/Cardiomyopathy: Arrhythmia-Free Survival After Endo-Epicardial Substrate Based Mapping and Ablation","volume":"4","author":"Bai","year":"2011","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1161\/CIRCEP.110.957290","article-title":"Long-Term Outcomes of Combined Epicardial and Endocardial Ablation of Monomorphic Ventricular Tachycardia Related to Hypertrophic Cardiomyopathy","volume":"4","author":"Dukkipati","year":"2011","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.hrthm.2010.05.022","article-title":"Radiofrequency catheter ablation of ventricular arrhythmias in patients with hypertrophic cardiomyopathy: Safety and feasibility","volume":"7","author":"Santangeli","year":"2010","journal-title":"Heart Rhythm"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1016\/j.prp.2017.07.015","article-title":"Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) in a young female athlete at 36 weeks gestation: A case report","volume":"213","author":"Choung","year":"2017","journal-title":"Pathol. Res. Pract."},{"key":"ref_44","first-page":"564","article-title":"Idiopathic intrafascicular reentrant left ventricular tachycardia in an elite cyclist athlete","volume":"16","author":"Riera","year":"2009","journal-title":"Cardiol. J."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/3\/205\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:29:11Z","timestamp":1760160551000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/3\/205"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,26]]},"references-count":44,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["medicina57030205"],"URL":"https:\/\/doi.org\/10.3390\/medicina57030205","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,26]]}}}