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.............................................................................................................. with either biventricular or His-bundle pacing is appropriate.569572 Long-term medical therapy with beta-blockers, and angiotensinconverting enzyme inhibitors or angiotensin II receptor blockers, is indicated before and after successful ablation for the known beneficial effects of these drugs on the LV remodelling process. Given the risk of recurrence of arrhythmias, long-term monitoring of patients is recommended. 16 Supraventricular tachycardia in sports Athletes with frequent supraventricular arrhythmias should be assessed to exclude the presence of an underlying cardiac disease, electrolyte imbalance, thyroid dysfunction, and the use of stimulants or performance-enhancing drugs. Table 13 outlines the recommendations for sports eligibility of patients with SVT.573,574 Ventricular pre-excitation (WPW syndrome) is a rare cause of sudden cardiac death in young athletes.575 Although many individuals with ventricular pre-excitation remain asymptomatic throughout their lives, symptomatic AVRT may occur. Patients with WPW may also develop other arrhythmias, such as AF, which could degenerate into ventricular fibrillation and sudden cardiac death. Because sports activity has been associated with an increased risk of AF,576 athletes with ventricular pre-excitation have an increased risk of sudden cardiac death if the AP has the potential for fast antegrade conduction. Thus, catheter ablation of the AP is currently recommended in symptomatic athletes with ventricular pre-excitation. Asymptomatic athletes with intermittent pre-excitation (at rest or during exercise) or abrupt disappearance of pre-excitation during stress testing may be considered to be at low risk (see section 11.3.11 for reservations), but should be further evaluated as they may be eligible for competitive sports activity. In asymptomatic athletes with ventricular pre-excitation, invasive risk stratification should be conducted as described in section 11.3.11 and catheter ablation should be performed in those with high-risk features.577 Asymptomatic patients stratified at low risk are allowed to practice competitive sports. AVNRT, orthodromic AVRT over a concealed AP, and AT are not listed among the causes of sudden cardiac death during exercise in patients with a structurally normal heart. However, their occurrence during sports activity may be associated with very high heart rate because of sympathetic stimulation and may cause haemodynamic impairment even in patients with structurally normal hearts. Accordingly, catheter ablation should generally be recommended for all athletes with a history of paroxysmal SVT. Athletes with SVT who do not wish to undergo catheter ablation, or in whom the procedure has been unsuccessful, may be considered eligible for competitive sports activity if the arrhythmia is sporadic, unrelated to cardiac disease, well tolerated, and unrelated to exercise, and when the sports activity does not have a high intrinsic risk of loss of consciousness (such as divers, pilots, horse riders, etc.).578 Treatment of paroxysmal SVT with beta-blockers or sodium channel blockers is discouraged in athletes, because these drugs may reduce performance during sports and have limited ability to prevent arrhythmia recurrence during sports activity. Moreover, betablockers are listed by the World Anti-Doping Agency as prohibited drugs in particular sports. 17 Supraventricular tachycardia and driving restrictions The frequency of which medical causes contribute to motor vehicle accidents is not precisely known. Data on arrhythmias as a cause of motor vehicle accidents are hard to obtain due to the difficulty of documenting such events in the general population. However, the proportion is believed to be small, with 1 - 3% of all motor vehicle accidents established as being due to a driver’s sudden incapacitation.579 Of these accidents, 5 - 10% are related to cardiac causes, with Table 13 Recommendations for sports participation in athletes with ventricular pre-excitation and supraventricular arrhythmias Criteria for eligibility Eligibility Premature atrial beats No symptoms, no cardiac disease All sports AVRT or AF in the context of WPW syndrome Ablation is mandatory. Sports are allowed 1 month after ablation if there are no recurrences All sports Asymptomatic ventricular pre-excitation Ablation is mandatory in patients at high risk. Sports are allowed 1 month after ablation if there are no recurrences All sports Paroxysmal SVT (AVNRT, AVRT over a concealed AP, and AT) Ablation is recommended. Sports are allowed 1 month after ablation if there are no recurrences All sports All sports, except those with high intrinsic risk of loss of consciousness Ablation undesirable or not feasible AF = atrial fibrillation; AP = accessory pathway; AT = atrial tachycardia; AVNRT = atrioventricular nodal re-entrant tachycardia; AVRT = atrioventricular re-entrant tachycardia; SVT = supraventricular tachycardia; WPW = WolffParkinsonWhite Downloaded from academic.oup.com/eurheartj/article/41/5/655/5556821 by guest on 07 October 2026