Arrhythmias & electrophysiologyCohort study
Bradycardia in Athletes: Prevalence, Mechanisms, and Risks
- Prospective cohort study
- genetic comparison with nonathletic controls
Authors' conclusion
Resting bradycardia (HR ≤40 bpm) and pauses of 2 to 3 s are present in a significant proportion of endurance athletes and are well tolerated.
Study context
- Population
- Current and former elite endurance athletes, Pro@Heart cohort
- Participants
- 465 endurance athletes
- Exposure
- BAs vs non-BAs vs ASPREE nonathletes
- BAsn = 175
- Outcome
- Prevalence of bradycardia (minimum HR ≤40 bpm on Holter) and its genetic contribution (HR-PRS)
Main finding
As reported in the abstract
Bradyarrhythmias on Holter
- Minimum HR ≤40 bpm
- 175 (38%)
- HR ≤30bpm
- 7 (2% of total)
- Pauses ≥2 s
- 115 (25%)
- Pauses ≥3 s
- 12 (3% of total)
- Mobitz I second-degree AV block
- 15 (3% of total)
Observational data: associations, not effects.
Further findings
| Outcome | Values | OR (95% CI) | P value | |
|---|---|---|---|---|
| Resting bradycardia by HR-PRS (adjusted for age, sex, fitness, indexed right atrial volume) | 2.2 (1.3–3.9) | P = 0.004 | ||
| 0.20.5125Odds ratio (log scale) |
| Outcome | Values | Estimate | P value |
|---|---|---|---|
| Mean HR-PRS — All athletes vs ASPREE nonathletes · significantly lower in athletes | P < 0.001 | ||
| Mean HR-PRS — BAs vs non-BAs · significantly lower in BAs | P = 0.006 | ||
| Minimum HR, HR-PRS bottom vs top quartile | Bottom quartile median 41 (IQR 35–45) bpm · Top quartile median 45 (IQR 40–49) bpm | P < 0.001 | |
| Bradycardia burden, HR-PRS bottom vs top quartile | Bottom quartile 14 (IQR 2–37) % · Top quartile 2 (IQR 0%–25) % | P < 0.001 |
BAs vs non-BAs characteristics
- BAs younger, fitter, with greater athletic cardiac remodeling than non-BAs
Safety
Adverse outcomes · 5.5 years
- Neither bradycardia nor pauses associated with increased risk of adverse outcomes
Original publication
Bradycardia in Athletes: Prevalence, Mechanisms, and Risks. Circulation. Published 18 December 2025. doi:10.1161/circulationaha.125.076170
Summarised from the published abstract; every number is checked against it