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Heart Rate Monitor Instead of Ablation? Atrioventricular Nodal Re-Entrant Tachycardia in a Leisure-Time Triathlete: 6-Year Follow-Up

Center for Sports Cardiology at the Gajda-Med Medical Centre in Pułtusk, ul. Piotra Skargi 23/29, 06-100 Pułtusk, Poland
Diagnostics 2020, 10(6), 391; https://doi.org/10.3390/diagnostics10060391
Received: 1 June 2020 / Revised: 8 June 2020 / Accepted: 8 June 2020 / Published: 10 June 2020
(This article belongs to the Special Issue Diagnostic Challenges in Sports Cardiology)
This study describes a triathlete with effort-provoked atrioventricular nodal re-entrant tachycardia (AVNRT), diagnosed six years ago, who ineffectively controlled his training load via heart-rate monitors (HRM) to avoid tachyarrhythmia. Of the 1800 workouts recorded for 6 years on HRMs, we found 45 tachyarrhythmias, which forced the athlete to stop exercising. In three of them, AVNRT was simultaneously confirmed by a Holter electrocardiogram (ECG). Tachyarrhythmias occurred in different phases (after the 2nd–131st minutes, median: 29th minute) and frequencies (3–8, average: 6.5 times/year), characterized by different heart rates (HR) (150–227 beats per minute (bpm), median: 187 bpm) and duration (10–186, median: 40 s). Tachyarrhythmia appeared both unexpectedly in the initial stages of training as well as quite predictably during prolonged submaximal exercise—but without rigid rules. Tachyarrhythmias during cycling were more intensive (200 vs. 162 bpm, p = 0.0004) and occurred later (41 vs. 10 min, p = 0.0007) than those during running (only one noticed but not recorded during swimming). We noticed a tendency (p = 0.1748) towards the decreasing duration time of tachycardias (2014–2015: 60 s; 2016–2017: 50 s; 2018–later: 37 s). The amateur athlete tolerated the tachycardic episodes quite well and the ECG test and echocardiography were normal. In the studied case, the HRM was a useful diagnostic tool for detecting symptomatic arrhythmia; however, no change in the amount, phase of training, speed, or duration of exercise-stimulated tachyarrhythmia was observed. View Full-Text
Keywords: AVNRT; endurance training; HRM; triathlon; exertion cardiac arrhythmia; Holter ECG AVNRT; endurance training; HRM; triathlon; exertion cardiac arrhythmia; Holter ECG
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Gajda, R. Heart Rate Monitor Instead of Ablation? Atrioventricular Nodal Re-Entrant Tachycardia in a Leisure-Time Triathlete: 6-Year Follow-Up. Diagnostics 2020, 10, 391.

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