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Symptomatic second-degree atrioventricular block in a recreational athlete
  1. Manisha Gandhi1,2 and
  2. Honey Thomas1
  1. 1Cardiology, Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
  2. 2Cardiology, Department of Medicine, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Manisha Gandhi; manisha.20{at}


This case study provides an example of bradycardia associated with an increase in exercise training in a recreational athlete. Although recognised among high-level endurance athletes, this case demonstrates the potential negative effects of exercise on the heart in a patient participating in the levels of exercise recommended by Public Health England. It adds weight to the ongoing discussion of the incomplete understanding of the level of exercise needed to induce pathological changes in cardiac physiology. We discuss the investigations that led us to our diagnosis, highlighting the importance of a detailed exercise history in patients who present with palpitations and provide a potential explanation of how this phenomenon may have occurred. Currently, bradycardia induced by exercise has been managed through pacemaker insertion or complete cessation of exercise. This report demonstrates effective treatment through a period of exercise cessation and slow reintroduction of exercise training.

  • cardiovascular medicine
  • arrhythmias
  • pacing and electrophysiology
  • sports and exercise medicine

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  • Contributors MG supervised and directed by HT.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.