Cardiac arrhythmias

Dr Chris Milne: Medical Director, Rowing New Zealand

What is your experience as a team physician in dealing with insidious onset of cardiac disorders in rowers?

Any rower who presents with palpitations should be taken seriously, as these may be an indicator of significant cardiac arrhythmia. The many years of hard endurance training causes adaptive changes that are collectively known as ‘the athlete's heart’. Sometimes these changes progress from normal adaptation to volume overload to unhealthy sequelae.

The most common arrhythmia seen in rowers is atrial fibrillation, and the longer the rower has been in heavy training, typically over 10 years, the more likely it is that they will develop this arrhythmia. The exact mechanism is unclear but it may be due to atrial enlargement with dilation and fibrosis plus a contribution from increased vagal tone and bradycardia.

The condition presented dramatically for Rob Waddell in the trials for the single berth at Beijing Olympics. In New Zealand, several athletes’ rowing careers have been affected by atrial fibrillation or other arrhythmias. Nathan Cohen, gold medallist in the London 2012 Olympics, had to retire following several episodes of arrhythmia.

Can these conditions be detected by routine screening?

The history and physical examination occasionally provide clues. A resting ECG (recently introduced by Fédération Internationale des Sociétés d'Aviron (FISA) as a requirement at World Championships at Under-23 level (U23)) can provide additional clues to underlying cardiac disorders (eg, hypertrophic cardiomyopathy) and may prompt referral for other more advanced investigations, for example, echocardiography or electrophysiological studies. Liaison with a cardiologist who has an interest in these issues is recommended.

Rob Waddell: Athlete, Olympic Champion, single scull (Sydney 2000), 2× world champion.

What was your experience as an athlete with a cardiac abnormality and what challenges did you face in obtaining a diagnosis?

I was only …