Treating Athletes with Arrhythmias: A Partnership Approach

Arrhythmias pose a particular cardiovascular concern for patients of all ages who pursue athletic endeavors at any level, from casual runners to elite athletes. Collaborative efforts between the Massachusetts General Hospital’s Cardiovascular Performance Program and Electrophysiology Section led to the formation of the Athlete Arrhythmia Clinic (AAC) which provides care for athletic patients across the age spectrum with arrhythmias. Relying on a unique, shared decision-making approach, Mass General’s sports cardiologists and heart rhythm specialists work in close collaboration to maximize patient engagement and state-of-the-art management strategies.

“Most people in the medical community realize that physical activity is one of the best ways to stay healthy. Still, even competitive athletes can and do end up with arrhythmias, sometimes completely independent of what they do physically. In other cases, an athlete’s exercise habits may actually increase their likelihood of having arrhythmias,” explains Aaron Baggish, MD, director of the Cardiovascular Performance Program at the Massachusetts General Hospital Corrigan Minehan Heart Center.

The key to Mass General’s success in caring for athletes with common and complex arrhythmias is a close partnership between Dr. Baggish and Conor Barrett, MBBCh, BAO, clinical director of Mass General’s Telemachus & Irene Demoulas Family Foundation Center for Cardiac Arrhythmias. Together, Drs. Barrett and Baggish lead Mass General’s collaborative AAC.

Athletes with Heart Disease Have Unique Needs

Athletes who have (or are at risk for) heart disease require a specialized level of care. “Because of the cardiovascular demands of exercise, athletes who experience heart problems should seek out a provider who understands physical activity as well as heart disease,” says Dr. Baggish.

He defines “athlete” as anyone who places a high premium on physical activity for any reason, including:

• Professional and elite-level athletes
• Recreational athletes
• People who exercise regularly for health benefits
• People who require physical activity for their occupation, such as firefighters

Diagnosing Arrhythmias

The first of two main pillars of Mass General’s approach to arrhythmia care for athletes is ensuring a comprehensive diagnosis. This step is crucial for all cardiac problems but is particularly relevant for athletes with arrhythmias.

“Diagnosing an arrhythmia is complicated by multiple factors. First, there are several different types of arrhythmias, with varying degrees of severity. An arrhythmia is anything from straightforward rhythm inconsistencies from the atria to more complex ventricular arrhythmias,” says Dr. Barrett. “Second, an arrhythmia may develop on its own or as related to a separate medical problem. Knowing the nature of an arrhythmia is essential to an accurate diagnosis and getting patients the care they need.”

The team’s vast experience caring for athletes with cardiac conditions helps diagnosis efforts, as do Mass General’s extensive cardiac imaging options and sophisticated Cardiopulmonary Exercise Laboratory designed to test people under conditions that simulate the way they train and compete in the outside world.

Once Mass General’s team pinpoints what is causing a patient’s arrhythmia, specialists then determine the level of risk it poses to an athlete. “Some patients have arrhythmias that are potentially life threatening; others may interfere with quality of life or sports performance but are not generally threatening significant threat to their health,” says Dr. Barrett. These details determine the treatment approach.

“Understanding all forms of heart and non-cardiac diseases, as well as lifestyle patterns around athletic patients, helps us precisely diagnose an arrhythmia. We can then set realistic expectations for patients in terms of treatment outcomes, rehabilitation and timing to return to full competitive sports,” says Dr. Baggish.

Shared Decision-Making in Arrhythmia Treatment

The second pillar of the Cardiovascular Performance Program actively engages athletes in their care. “Our shared decision-making approach involves very carefully understanding an athlete’s past, present and future goals,” says Dr. Baggish.

Once Mass General’s team assesses an athlete’s arrhythmia risk, they talk through a series of treatment options. Arrhythmia treatments range from no treatment at all, to medication or aggressive treatment with leading intracardiac catheter-based techniques.

In this care paradigm, treatment is not directed solely toward the arrhythmia alone but rather toward the entire person and his or her athletic goals. This care approach allows Mass General physicians to safely and effectively treat a patient’s arrhythmia with a level of nuance that maximizes return-to-play. “Using the specialized knowledge that our team has in this area, we discuss the treatment options we feel are the best fit for that patient,” Dr. Barrett explains. “This personal care approach contributes to the level of safety we provide and our excellent outcomes for intricate arrhythmia treatments.”

Mass General’s Multidisciplinary Arrhythmia Treatment Approach

At Mass General, experts in sports cardiology and electrophysiology partner to provide comprehensive cardiovascular care and physiologic testing for active individuals with cardiac concerns. The team includes:

• Sports cardiologists
• Electrophysiologists
• Imaging specialists
• Cardiac geneticists
• Interventional radiologists

Notably, the convergence of Dr. Baggish’s sports cardiology expertise with Dr. Barrett’s cardiac arrhythmia proficiency sets Mass General apart in its approach to arrhythmias in the active patient population. “This program provides both a high-level medical approach and a high-level sports cardiology approach to understanding the disease as well as the performance capacities of our patients,” says Dr. Barrett. “We’ve put together a multidisciplinary team that cares for athletic and active people with arrhythmias in a way that is not being done anywhere else.”

Dedicated Care for Athletes with Arrhythmias

Mass General sees such a large number of athletes with arrhythmias that it dedicated a multidisciplinary clinic to the patient population. What can often take several weeks with stepwise appointments and multiple referrals at other sites now can be accomplished in one visit.

At the monthly AAC sessions, patients can complete multiple aspects of care in one visit, including:

• A consultation with a sports cardiologist and an electrophysiologist
• Imaging scans
• Exercise performance testing

Caring for athletes with arrhythmias requires an understanding of athletes as well as every available management strategy for arrhythmias. "One without the other is suboptimal care," says Dr. Baggish.

“While we always place patients’ health and safety as our first priority, we consider returning people to their athletic prowess a close second,” he says. “We understand how important sports activities can be to an athlete’s identity, and we make every effort to get people back to their activity level as quickly as possible.”

Refer a patient to the Cardiovascular Performance Program

Learn more about the Telemachus & Irene Demoulas Family Foundation Center for Cardiac Arrhythmias