The Emergence of Sports Electrophysiology: Care of Athletes With Arrhythmias, From the ACC's Sports and Exercise Cardiology Leadership Council.

Sports cardiology is a cardiovascular subspecialty that cares for competitive athletes and highly active individuals with cardiovascular risk factors and/or disease. Exercise can lead to physiological, structural, and electrical cardiac remodeling while also contributing to maladaptive changes, including arrhythmias. These nuances have contributed to the emergence of sports electrophysiology as a specialized extension within sports cardiology, dedicated to understanding arrhythmias, including best practices in arrhythmia management in this patient group. Although the diagnosis and treatment of arrhythmias in athletes often parallel standard electrophysiological practices, there are differences and factors to be taken into account. Examples include exercise type and intensity; potential performance effects and side effects of antiarrhythmic therapies; timing and indications for catheter ablation; device selection and programming for cardiac implantable electronic devices when applicable; interpretation of cardiovascular testing; and return-to-play guidance. In this state-of-the-art review, athletic electrical remodeling, clinical considerations for arrhythmia management in athletes, device-related matters, and future directions for the evolving field of sports electrophysiology are discussed. This document builds on recent clinical references by providing practical clinical guidance for electrophysiologists and cardiovascular clinicians who care for athletic patients with arrhythmias and formally introduces the concept of "sports electrophysiology" within sports cardiology as a novel discipline.