Cardiac specialized conduction system in competitive athletes

Competitive athletes are widely regarded as a special group of healthy individuals with a unique lifestyle whoare seemingly invulnerable and often capable of extraordinary physical achievement.Athlete’s heart is generally regarded as a benign increase in cardiac mass, with specific circulatory and cardiacmorphological alterations, that represents a physiological adaptation to systematic training. However, the clinical profileof athlete’s heart has expanded considerably over the last several years as a result of greater accessibility to largepopulations of trained athletes studied systematically with, ECG, ambulatory Holter ECG monitoring, stress test,echocardiography and cardiac magnetic resonance. As a consequence, there is increasing recognition of the impact thatprolonged conditioning has on cardiac remodeling, which may eventually mimic certain pathological conditions, suchas Brugada syndrome, with the potential for sudden death or disease progression.These findings indicate that atrioventricular conduction system abnormalities may play a fatal arrhythmogenic role andraise questions regarding the prevention of electrical instability in young people engaged in active sports. At last manydrugs have been associated with adverse events in Brugada syndrome patients and have been indicated to provoke thecharacteristic Brugada syndrome-linked ECG abnormalities and/or (fatal) ventricular tachyarrhythmias.