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Athlete-Specific Considerations
While some studies suggest that exercise does not alter accessory pathway characteristics, exercise appears to put some athletes with WPW at risk for a lethal arrhythmia.40,42,49 It is unclear whether these athletes are symptomatic before SCD.7 The cardiovascular care of athletes may utilize an ECG for screening or diagnostic purposes. WPW can be readily identified in asymptomatic athletes, and ECG allows early detection of young athletes at risk of SCD that have not manifested symptoms.
For athletes with WPW pattern on ECG, the 36th Bethesda Conference recommends that risk stratification with invasive EP studies is advisable for asymptomatic younger athletes engaged in moderate- to high-intensity competitive sports.33 Symptomatic athletes also should be considered for catheter ablation therapy of the accessory pathway prior to returning to sport.33 The European Society for Cardiology advises a more aggressive approach by recommending that all athletes identified with WPW undergo a comprehensive EP study, regardless of sport.8 While American and European recommendations differ, it is uniformly recommended that the discovery of ventricular pre-excitation in an adolescent, regardless of athletic involvement, should result in prompt referral to a cardiac electrophysiologist familiar with risk stratification.7
Ablation is recommended for high-risk pathways and symptomatic athletes. Competitive athletes with low-risk pathways identified during EP study not undergoing ablation therapy should be monitored for the development of new symptoms. After an athlete has undergone an ablation procedure, return to play is guided by symptoms and follow-up studies.33 Athletes who remain asymptomatic and have normal AV conduction properties on follow-up ECG (ie, normal QRS complex and PR interval) usually may return to sport within 1 week.
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