Project R-15504

Continuous Rhythm Monitoring in Athletes: Improving Screening Protocols, Diagnostics, and Return-to-Play Protocols (Research)

Sports cardiology has advanced rapidly in recent years, focusing on evidence-based methods to prevent sudden cardiac death, particularly in younger athletes. The primary goal of sports cardiologists is to assess the risk of cardiovascular events in individuals participating in various physical activities, from elite athletes to recreational sports enthusiasts. Although rare, exercise-induced sudden cardiac death (SCD), often due to underlying cardiovascular conditions, is the leading cause of mortality in athletes. The collapse of a young athlete during a sports event is a tragic occurrence, emphasising the importance of investigating the "athlete's heart," which refers to the cardiac structural and functional changes seen in athletes. Differentiating between physiological and pathological heart adaptations in those involved in high-intensity sports like cycling and rowing, which induce significant cardiovascular remodelling, is challenging. Intensive endurance exercise has been linked to an increased prevalence of fibrosis and both atrial and ventricular arrhythmias, some of which might predispose to sudden cardiac death. Moreover, research has shown that physical activity can expose arrhythmic substrates and expedite the progression of certain cardiomyopathies, such as arrhythmogenic cardiomyopathy. While arrhythmias such as premature ventricular contractions (PVCs) are recognised as a risk marker for heart failure in the general population, their significance in athletes remains unclear. Recent research suggests that athletes with reduced left ventricular ejection fractions may exhibit a greater burden of PVCs. However, assessing PVCs during single screening events complicates the differentiation between exercise-induced changes and pre-existing conditions. Additionally, athletes often present with symptoms in cardiology departments where existing monitoring tools—typically limited to spot checks—fail to detect potential arrhythmias that may not manifest during brief evaluations. For athletes with diagnosed cardiac conditions, sports restrictions are recommended, but the efficacy of these restrictions in reversing cardiac remodelling and decreasing arrhythmia burden remains unclear. Despite substantial advancements in sports cardiology, research into cardiac arrhythmias remains the Achilles' heel of sports cardiology, often neglected due to the challenges in capturing these events. The proposed PhD project, carried out by Dr. B. Delpire, represents the first large-scale research into telemonitoring within sports cardiology. Its first objective is to validate a scoring system for evaluating and comparing smart devices used in continuous rhythm monitoring of athletes and sports enthusiasts—a tool currently absent in the field. Given the rapid emergence of new devices and modalities, this system will enable objective comparison among various monitoring technologies. The project will employ this system to compare different continuous rhythm monitoring modalities and further assess telemonitoring's potential for early detection of myocardial fibrosis during preparticipation screening (PPS), improving diagnostic accuracy in symptomatic athletes, and monitoring arrhythmia burden in detraining protocols for individuals with adverse cardiac remodelling.

01 October 2024 - 30 September 2028