The Athlete's Heart-Challenges and Controversies: JACC Focus Seminar 4/4.

Regular exercise promotes structural, functional, and electrical remodeling of the heart, often referred to as the "athlete's heart," with intense endurance sports being associated with the greatest degree of cardiac remodeling. However, the extremes of exercise-induced cardiac remodeling are potentially associated with uncommon side effects. Atrial fibrillation is more common among endurance athletes and there is speculation that other arrhythmias may also be more prevalent. It is yet to be determined whether this arrhythmic susceptibility is a result of extreme exercise remodeling, genetic predisposition, or other factors. Gender may have the greatest influence on the cardiac response to exercise, but there has been far too little research directed at understanding differences in the sportsman's vs sportswoman's heart. Here in part 4 of a 4-part seminar series, the controversies and ambiguities regarding the athlete's heart, and in particular, its arrhythmic predisposition, genetic, and gender influences are reviewed in depth.
Competing Interests: Funding Support and Author Disclosures Dr La Gerche is supported by the National Heart Foundation of Australia. Dr Fatkin is supported by the Victor Chang Cardiac Research Institute, Heart Foundation, NSW Health, NHMRC. Dr Heidbuchel is supported by the Fund for Scientific Research, Flanders, with sports cardiology related grants T003717N and G099222N; has received personal lecture and consultancy fees from Abbott, Biotronik, Daiichi-Sankyo, Pfizer-Bristol Myers Squibb, Medscape, and Springer Healthcare Ltd; and has received unconditional research grants through the University of Antwerp and/or the University of Hasselt from Abbott, Bayer, Biotronik, Biosense Webster, Boston Scientific, Boehringer Ingelheim, Daiichi-Sankyo, Fibricheck/Qompium, Medtronic, and Pfizer-Bristol Myers Squibb, all outside the scope of this work. Dr Baggish has received funding to study topics relevant to this publication from the National Institute of Health/ National Heart, Lung, and Blood Institute, the National Football Players Association, and the American Heart Association; and receives compensation for his role as team cardiologist from the U.S. Olympic Committee / U.S. Olympic Training Centers, U.S. Soccer, U.S. Rowing, the New England Patriots, the Boston Bruins, the New England Revolution, and Harvard University. Prof Kovacic acknowledges research support from the National Institutes of Health (R01HL148167), New South Wales health grant RG194194, the Bourne Foundation and Agilent; and is the recipient of an Agilent Thought Leader Award (January 2022), which includes funding for research that is unrelated to the current paper. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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