L'évaluation des arythmies chez les athlètes nécessite plusieurs niveaux d’approche, en commençant par le diagnostic et en se terminant par le traitement et les décisions d'admissibilité139.
Bien que le diagnostic soit provoquant souvent, les décisions thérapeutiques et la détermination de l’éligibilité aux sports compétitives reste un problème encore plus difficile. L'existence des maladies cardiaques sous-jacentes, la gravité des symptômes, le type de l'arythmie et l'intensité de l'exercice entrepris sont les principaux facteurs sur lesquels les critères d'éligibilité de la Conférence de Bethesda et l’ESC se sont fondés. Bien que ces recommandations soient utiles pour déterminer la pertinence du sport de compétition ou la disqualification, une approche personnalisée est également nécessaire, à cause de l'approche controversée de certains cas parmi les recommandations. Le clinicien doit toujours garder à l’esprit que la décision de l'éligibilité est un équilibre délicat entre l'évitement de la mort subite et la disqualification incorrecte d'un athlète prometteur.
Une meilleure compréhension des réponses électrophysiologiques à l'exercice chronique, une meilleure compréhension du rôle des influences génétiques, ainsi qu’avec de nouvelles améliorations des techniques diagnostiques et thérapeutiques, on peut rendre la décision de participation sportive plus facile à prendre dans l'avenir.
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IX. RESUME
Personne ne conteste que l’activité sportive régulière a des effets bénéfiques pour la santé notamment cardiovasculaire et améliore l’espérance de vie. Peu cependant sont conscients, que des niveaux élevés d’entrainement physique prédisposent les sportifs à des troubles de rythme cardiaque.
Ces dernières années, avec l’intérêt mondial que revêtent les sports de haut niveau, les arythmies cardiaques chez l'athlète sont devenues une préoccupation majeure pour les praticiens. Certaines arythmies peuvent être bénignes et asymptomatiques, mais d'autres peuvent être graves, voire mortelles.
La bradycardie sinusale et la fibrillation auriculaire sont assez fréquentes chez le sportif et sont rarement une source de préoccupation. Les tachycardies supraventriculaires, autres que la fibrillation auriculaire, justifient généralement une ablation par radiofréquence. Les troubles du rythme ventriculaire chez l'athlète surviennent généralement dans le cadre d'une cardiopathie structurelle génétiquement déterminée (cardiomyopathie hypertrophique, dysplasie arythmogène du ventricule droit, anomalie des artères coronaires…) ou acquise (cardiopathie ischémique, myocardite, cardiomyopathies dilatées idiopathiques…).
Ainsi, tous les intervenants dans le domaine sportif (entraineurs, équipes médicales, fédérations, arbitres…) doivent se sentir concernés par les troubles du rythme cardiaque qui peuvent survenir chez les athlètes et de leur conséquence sur l’avenir de ces derniers.
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