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September 25, 2018 Circulation. 2018;138:e272–e391. DOI: 10.1161/CIR.0000000000000549 e338 CLINICAL STATEMENTS AND GUIDELINES placebo-controlled study of 674 patients with HF and LVEF <0.40 attributed to ischemic or NICM and ≥10 PVCs per hour, amiodarone significantly reduced VA, slowed heart rate, and was associated with an increase in LVEF by 42% at 2 years with a nonsignificant trend toward reduction in mortality.S9-4 Whether the VA was contributing to ventricular dysfunction in these patients is unknown. 10 VA AND SCD RELATED TO SPECIFIC POPULATIONS 10.1 Athletes In athletes, VAs range from isolated PVCs, couplets, and NSVT, to sustained VT and SCA leading to SCD.S10.1-1 Infrequent PVCs and short runs of repetitive NSVT, especially in the absence of structural heart disease, are more common in nonathletes, but they are generally benign, requiring only a limited workup and rarely lead to disqualification for sports.S10.1-2,S10.1-3 In contrast, longer runs of NSVT, especially when exercise-induced, and sustained VT and SCA/SCD are infrequent, but they have a higher incidence in athletes than that reported for the general population in the corresponding age groups. Reported estimates of SCD range from 1 per 53 703 athlete-years in the National Collegiate Athletic Association databaseS10.1-4 to <1 per 200 000 in Minnesota high school students.S10.1-5 Among those studies judged to have better epidemiological protocols, estimates were in the range of 1 per 40 000 to 1 per 80 000.S10.1-6 These figures compare with a general population risk of 1.0 to 1.9/100 000 in adolescents and young adults.S10.1-7,S10.1-8 Moreover, there appears to be both sport and sex differences in the magnitude of risk, with males being at higher risk than females in most sports,S10.1-7,S10.1-9 blacks at higher risk than whites, and male basketball players being the single highest risk group in the United States, 1 per 5200 athlete-years.S10.1-4 A study that included both competitive and recreational athletes showed that both groups are at a higher risk for SCD than the general population, with recreational athletes having greater cumulative numbers,S10.1-7 SCD occurring at an older age, and a different distribution of diseases. Postmortem data on SCD in athletes reveal that 25% to 40% are autopsynegative, suggesting a role for genetic molecular disorders in these victims S10.1-4,S10.1-10,S10.1-11 and for family members.S10.1-12 Another limitation of SCD data analysis in athletes centers on noncardiac causes, some of which mimic cardiac events. Noncardiac causes include acute neurological disorders, drug abuse, heat stroke, rhabdomyolysis, sickle cell disorders, suicides, and accidents.S10.1-13,S10.1-14 Nonetheless, arrhythmias in athletes remain the most common medical cause of death and many occur as the first cardiac event. The most common structural cause of SCAs and SCDs in athletes in the United States is HCM, followed by anomalous origins of coronary arteries, with myocarditis contributing a smaller but significant proportion.S10.1-15 Beyond these, the other inherited disorders contribute to the distribution of causes of a SCD in athletes, many of which can be suspected or identified by a careful family history and preparticipation ECGs. In general, management of arrhythmias in athletes follows that in nonathletes. In regard to interventions, it is now generally recommended that AEDs be available at training and facilities for competitive athletes,S10.1-16 with less specific statements for AED availability at venues (eg, tennis courts) or circumstances (eg, jogging or small group runs) in which recreational athletics are occurring. Many athletes who have had corrective procedures (repair of congenital or developmental defects such as anomalous origins of coronary arteries)S10.1-17,S10.1-18 are on therapy for inherited disordersS10.1-19 or have ICD implantsS10.1-1 and are able to participate in athletics depending on the nature and severity of the disease and with appropriate precautions and counseling regarding potential residual risks.S10.1-19,S10.1-20 For example, athletes with acquired disorders such as myocarditis are advised against exercise for at least 3 to 6 months after disease resolution. 10.2 Pregnancy Recommendations for Pregnancy References that support the recommendations are summarized in Online Data Supplement 51. COR LOE Recommendations I B-NR 1. In mothers with long QT syndrome, a beta blocker should be continued during pregnancy and throughout the postpartum period including in women who are breastfeeding.S10.2-1 I C-EO 2. In the pregnant patient with sustained VA, electrical cardioversion is safe and effective and should be used with standard electrode configuration.S10.2-2,S10.2-3 IIa B-NR 3. In pregnant patients needing an ICD or VT ablation, it is reasonable to undergo these procedures during pregnancy, preferably after the first trimester.S10.2-4,S10.2-5 Recommendation-Specific Supportive Text 1. Women with long QT syndrome should be counseled about maternal and fetal risks prior to Downloaded from http://ahajournals.org by on October 7, 2026