HRMs as athlete arrhythmia diagnostic tools?

“

The main strengths of our study are the simultaneous registration of HR by wearable leadless HRMs during exercise in a relatively large group of asymptomatic leisure time and competitive male and female athletes (runners and cyclists) with suspected exercise-induced cardiac arrhythmias. We analyzed the recorded HR data during typical endurance training using 15 devices made by recognized manufacturers and compared them to data obtained simultaneously using the “gold standard” Holter ECG monitor during the same exercise. We have not identified a similar study in the available scientific literature. Our study also has some limitations. Although the initial examination included 142 athletes with abnormal findings, only 65 of those athletes had an abnormal HRM reading during our study. The protocol did not identify the event the other 77 athletes had experienced in the past. Our observation was limited to only one typical endurance training session with a duration of approximately 60 minutes. We did not separately analyze the data from the different commercially available devices, and we did not analyze or compare the data obtained from the HRMs and Holter monitors during exercise in cardiac patients or in healthy, untrained individuals. Despite these limitations, we believe that the results of our study are important for physicians, coaches and large groups of leisure time and competitive sportspersons. Our data strongly suggest that surprisingly high HR values revealed by wireless HRMs during exercise in asymptomatic athletes without any malicious symptoms of exercise intolerance are mostly artifacts and are not grounds to recommend that athletes stop training or perform further time-consuming and mostly expensive medical diagnostics. In such cases, i.e., in recreational or competitive athletes with episodes of surprisingly high HRs during exercise, we propose that the proper function of the HRM device should be carefully controlled. If we exclude the typical error of HRM registration as described above, then the simultaneous monitoring of HR during typical endurance training with HRMs and Holter monitors is recommended. The algorithm presented in Fig. 3 might be of practical value in further medical diagnostics. Perspectives A physically active lifestyle is widely promoted for healthy individuals and large groups of patients.27 Millions of physically active individuals worldwide use HRMs to control exercise intensity.25,26 False “arrhythmias” or surprisingly high bursts of HR during exercise can induce fear in physically active individuals and might cause them to reduce or even abstain from training or to seek unnecessary, time-consuming and costly medical diagnostics. Thus, further studies should examine whether newly developed or improved HRMs yield fewer false HR measurements during exercise. Further studies should also address the following question: Are HRMs valuable tools for monitoring arrhythmias in symptomatic endurance athletes? Studies verifying the value of newly developed mobile devices, such as ECG Patch Monitoring or Time Smart Phone Monitoring, Injectable Loop Recorders, Device-tailored monitors and other devices, in diagnosing exercise-induced arrhythmias in large groups of competitive and recreational athletes, untrained apparently healthy individuals and cardiac patients would be interesting. Based on the recent studies,5, 28 as well as on many other previously published papers, competitive sportspersons are not immune to cardiac arrhythmias and the risk of sudden death

”