The Athlete’s Heart Paradox: Managing Arrythmias at Peak Performance

The Athlete’s Heart Paradox: Managing Arrythmias at Peak Performance

 

Guest: Guru Kowlgi, M.D.
Host: Anthony Kashou, M.D.

 

Exercise is one of the best prescriptions for cardiovascular health—but can there be too much of a good thing? In highly trained athletes, years of intensive exercise can produce electrical, autonomic, and structural changes that may increase susceptibility to arrhythmias, while in other cases exercise may uncover an underlying cardiac condition. Dr. Guru Kowlgi discusses how clinicians can distinguish normal adaptations of the athlete’s heart from warning signs that warrant further evaluation, including exertional syncope, declining performance, and increasingly complex ventricular arrhythmias. He also explores individualized treatment strategies, from medications to catheter ablation, and the growing role of shared decision-making when determining whether an athlete can safely return to competition. Finally, the discussion puts sudden cardiac death in athletes into perspective and highlights the importance of both identifying those at increased risk and being prepared with CPR and rapid access to AEDs when unexpected cardiac arrest occurs.

 

Topics discussed:

• Why can sustained, high-level endurance training increase the risk of arrhythmias such as atrial fibrillation in some athletes?
• Which rhythm findings are normal adaptations of the athlete’s heart, and which symptoms or arrhythmias should raise concern?
• How can arrhythmias be treated while preserving an athlete’s ability to exercise, compete, and maintain performance?
• When might catheter ablation be preferable to medication for athletes with arrhythmias?
• Which underlying cardiac conditions increase the risk of sudden cardiac death in athletes, and how can clinicians, teams, and coaches prepare for cardiac emergencies?

 

Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on X: @MayoClinicCV 

LinkedIn: Mayo Clinic | LinkedIn

 

Cardiovascular Education App:
The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today!

No CME credit offered for this episode.

 

Podcast episode transcript found here.

 

Recording date: 30-September-2026