Key Points

• Bradyarrhythmias caused by increased resting vagal tone are common in athletes and include sinus bradycardia, sinus arrhythmia, first-degree atrioventricular block, and Wenckebach (Mobitz I) second-degree AV block.

• Mobitz II second-degree and complete third-degree AV blocks are always pathologic and warrant cardiologic evaluation.

• Supraventricular tachyarrhythmias in the athlete are abnormal and require further evaluation and treatment, often with radiofrequency ablation, before participation in strenuous exercise.

• Ventricular arrhythmias are life-threatening events and usually occur in the presence of structural heart disease or ion channel disorders.

• Hypertrophic cardiomyopathy, coronary artery anomalies, and commotio cordis are the most common causes of sudden cardiac death in young U.S. athletes.

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