July 18, 2025

expert reaction to study looking at scarring and heart arrhythmia in veteran male athlete’s hearts

A study published in Circulation: Cardiovascular Imaging looks at cardiac scarring and arrhythmia in veteran males. 

Prof Steffen Petersen, Professor of Cardiovascular Medicine, Queen Mary University of London; Consultant Cardiologist at Barts Health NHS Trust; BHF Data Science Centre Interim Director; and Immediate Past President, European Association of Cardiovascular Imaging, said:

“This study is an important contribution to improving our current understanding of the long-term heart health impact of endurance exercise in older asymptomatic male athletes.  First, scar formation in the heart is common in about half of those athletes enrolled.  Second, a type of scar which is not due to poor blood supply of the heart muscle predicts the occurrence of ventricular arrhythmias, but a very common type (insertion point between the left and right heart) is not concerning, which is reassuring to know.

“A strength of the study is the confidence we can have in the accuracy of the outcome regarding ventricular arrhythmias, as determined by implantable loop recorders.  A weakness is the limited generalisability of the findings due to the small sample size, exclusive inclusion of male endurance athletes over 50 years of age from a single centre.”

Prof James Ware, Professor of Cardiovascular and Genomic Medicine, Imperial College London and the MRC Laboratory of Medical Sciences, and NHS consultant cardiologist, said:

“This is in my opinion a well designed and well executed study.  The authors themselves acknowledge the principal limitations of the study, and the conclusions are balanced and fair.  The press release is a fair reflection of the science described in the article.

“I would note:

“This is a highly selected group of competitive athletes who have trained intensively for many years.  I would not expect these findings to have direct relevance to most recreational athletes, and I would not want anyone to be scared of exercise as a result of this study.  Regular physical activity is hugely beneficial for the vast majority of people, and I would encourage participation and enjoyment.  Dr Swoboda emphasises this in his own comments.

“Nonetheless, fibrosis (scarring) is evidently more common in these high intensity athletes, and associated with heart rhythm abnormalities.  This is something we need to understand better.

“Most of the arrhythmias observed were non-sustained ventricular arrhythmia (NSVT) – that is short runs of abnormal rhythm lasting <30secs, that revert to normal rhythm without treatment.  These are not usually dangerous rhythms in themselves, but rather can be heralds of more dangerous rhythms.  Three people had sustained ventricular arrhythmia that was symptomatic and could be more dangerous.  I highlight this just to emphasise that although almost a half of athletes had scarring, and about one in five had a ventricular arrhythmia, the number was dangerous rhythms was much smaller during the follow up period (which averaged 2 years).  We will need more data to really pin down the absolute risk of a life-threatening rhythm in the longer term.   But I think these findings highlight an important issue for this group.”

‘VENTricular arrhythmia and cardiac fibrOsis in endUrance eXperienced athletes (VENTOUX)’ by Wasim Javed first author et al. was published in Circulation: Cardiovascular Imaging at 00:01 UK time on Friday 18 July 2025. 

Declared interests

Prof Steffen Petersen: “Disclosures:

1. Consultancy, Circle Cardiovascular Imaging, Inc., Calgary, Alberta, Canada (in my view no conflict related to this work).
2. Named reviewer of two relevant European guidelines:

1. Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesselink JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M; ESC Scientific Document Group. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2021 Jan 1;42(1):17-96. doi: 10.1093/eurheartj/ehaa605. Erratum in: Eur Heart J. 2021 Feb 1;42(5):548-549. doi: 10.1093/eurheartj/ehaa835. PMID: 32860412.
2. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, Benetos A, Biffi A, Boavida JM, Capodanno D, Cosyns B, Crawford C, Davos CH, Desormais I, Di Angelantonio E, Franco OH, Halvorsen S, Hobbs FDR, Hollander M, Jankowska EA, Michal M, Sacco S, Sattar N, Tokgozoglu L, Tonstad S, Tsioufis KP, van Dis I, van Gelder IC, Wanner C, Williams B; ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol. 2022 Feb 19;29(1):5-115. doi: 10.1093/eurjpc/zwab154. PMID: 34558602.

3. Author of relevant European consensus paper:

Galderisi M, Cardim N, D’Andrea A, Bruder O, Cosyns B, Davin L, Donal E, Edvardsen T, Freitas A, Habib G, Kitsiou A, Plein S, Petersen SE, Popescu BA, Schroeder S, Burgstahler C, Lancellotti P. The multi-modality cardiac imaging approach to the Athlete’s heart: an expert consensus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015 Apr;16(4):353. doi: 10.1093/ehjci/jeu323. PMID: 25681828.”

Prof James Ware: “I was not involved in this study, though have collaborated with Dr Swoboda on other research projects.

Industry relationsships (in the last 2 years):  I have received research support from Bristol Myers Squibb, and have acted as a paid advisor to Health Lumen, Tenaya Therapeutics, and Solid Biosciences.  I am a founder with equity in Saturnus Bio.

I do not consider that these relationships are directly related to the subject of this paper.”