Amateur Athlete with Sinus Arrest and Severe Bradycardia Diagnosed through a Heart Rate Monitor: A Six-Year Observation-The Necessity of Shared Decision-Making in Heart Rhythm Therapy Management

Robert Gajda, Beat Knechtle, Anita Gębska-Kuczerowska, Jacek Gajda, Sebastian Stec, Michalina Krych, Magdalena Kwaśniewska, Wojciech Drygas, Robert Gajda, Beat Knechtle, Anita Gębska-Kuczerowska, Jacek Gajda, Sebastian Stec, Michalina Krych, Magdalena Kwaśniewska, Wojciech Drygas

Abstract

Heart rate monitors (HRMs) are used by millions of athletes worldwide to monitor exercise intensity and heart rate (HR) during training. This case report presents a 34-year-old male amateur soccer player with severe bradycardia who accidentally identified numerous pauses of over 4 s (maximum length: 7.3 s) during sleep on his own HRM with a heart rate variability (HRV) function. Simultaneous HRM and Holter ECG recordings were performed in an outpatient clinic, finding consistent 6.3 s sinus arrests (SA) with bradycardia of 33 beats/min. During the patient's hospitalization for a transient ischemic attack, the longest pauses on the Holter ECG were recorded, and he was suggested to undergo pacemaker implantation. He then reduced the volume/intensity of exercise for 4 years. Afterward, he spent 2 years without any regular training due to depression. After these 6 years, another Holter ECG test was performed in our center, not confirming the aforementioned disturbances and showing a tendency to tachycardia. The significant SA was resolved after a period of detraining. The case indicates that considering invasive therapy was unreasonable, and patient-centered care and shared decision-making play a key role in cardiac pacing therapy. In addition, some sports HRM with an HRV function can help diagnose bradyarrhythmia, both in professional and amateur athletes.

Keywords: athlete’s heart; block S-A; bradyarrhythmia; cardioneuroablation; deconditioning; heart rate monitors; heart rate variability; leisure time activity; pacing therapy; shared decision-making.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
An example of a 30 s HRV printout recorded on an HRM that was compared with the ECG Holter recordings. The R-R interval (column 2) was evaluated while considering the recording time, here given in s after the start of the recording (column 1). The longest interval is 6.118 s, marked in red. The second longest interval is 3.749 s, marked in blue. R-R interval, interval between consecutive beats (i.e., the interval between two R-waves of QRS complexes in ECG); FFT, the fast Fourier transform; PSD, power spectral density; AR, autoregressive.
Figure 2
Figure 2
Holter ECG printout (A) and the corresponding printout from the HRV function of the HRM (B) showing the longest pause recorded on both devices. Red color-the longest pause.
Figure 3
Figure 3
Longest pause recorded exclusively on the HRM through its HRV function, of 7.3 s. (red).
Figure 4
Figure 4
ECG of the examined athlete.
Figure 5
Figure 5
Intrinsic and extrinsic causes of bradycardia [16].
Figure 6
Figure 6
The HRV analysis capabilities of the Polar 800V HRM. The red arrow shows a pause of 6.118 s and the blue arrow shows a pause of 3.749 s between the R-R waves marked in the same color in Figure 1. The abbreviations in the figure are be defined because they are irrelevant to the purposes of this article.

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