A recent State-of-the-Art Review published in JACC: Clinical Electrophysiology introduces "sports electrophysiology" as an emerging area within sports cardiology and offers practical guidance for electrophysiologists and cardiovascular clinicians caring for athletic patients with arrhythmias.

In the article, Eugene H. Chung, MD, MPH, FACC, and other members of ACC's Sports and Exercise Cardiology Member Section's Leadership Council discuss athletic electrical remodeling, clinical considerations for arrhythmia management in athletes, device-related matters and future directions for sports electrophysiology (EP).

The review outlines how electrical remodeling can occur in athletes and highlights the importance of accounting for athlete-specific factors when diagnosing and treating this population. It also reviews diagnostic tools such as exercise stress testing, 12-lead ECG and cardiac imaging, ambulatory rhythm monitoring, wearables, and EP studies.

Because certain cardiac conditions are more commonly encountered in sports EP, the authors provide practical guidance on evaluating and managing athletes with atrial fibrillation, sinus node dysfunction, Wolff-Parkinson-White pattern and syndrome, supraventricular tachycardia, premature ventricular complexes, cardiac channelopathies, genetic cardiomyopathies, and commotio cordis.

Additional priorities include key factors to consider for pacemakers and ICDs in competitive athletes, as well as care considerations for pediatric athletes, female athletes, tactical athletes and exercise prescription.

The authors emphasize that the field's growth will require coordinated work across sports cardiology and EP. "Multifaceted collaboration between the sports cardiology and [EP] communities is essential to advance research priorities, standardize clinical care pathways and develop evidence-based consensus recommendations," write Chung and colleagues. "…the development of multidisciplinary athlete-centered arrhythmia clinics, the incorporation of educational opportunities into current cardiology training curricula, and formal training pathways in sports EP will further expand clinical and research expertise."