Cardiac pauses in competitive athletes: A systematic review examining the basis of current practice recommendations

Tunay Senturk, Hai Xu, Krishna Puppala, Balaji Krishnan, Scott Sakaguchi, Lin Y. Chen, Rehan Karim, Oana Dickinson, David G. Benditt

Research output: Contribution to journalReview articlepeer-review

9 Scopus citations


Aims: It is generally recommended that individuals aspiring to competitive sports should undergo pre-participation cardiovascular assessment, particularly including arrhythmia risk evaluation. In regard to bradyarrhythmias, the 36th Bethesda Conference suggested that asymptomatic cardiac pauses ≤3 s are 'probably of no significance', whereas longer 'symptomatic' pauses may be abnormal. This study focused on assessing the evidence for the '3 s' threshold. Methods: A systematic literature search was undertaken including Embase (1980-) and Ovid Medline (1950-). The following MeSH terms were used in the database searches: & Additionally, pertinent publications found by review of citation lists of identified publications were examined. Individuals with reversible causes of bradyarrhythmia (e.g. drugs) were excluded. Results: The study population comprised 194 individuals with cardiac pauses of 1.35-30 s. In 120 athletes, specific records for pause durations were provided, but it was not always clear whether pauses occurred at rest. Among these 120 athletes, 106 had pauses ≤3 s, of whom 92 were asymptomatic and 14 were symptomatic. Fourteen athletes had pauses.3 s, of whom nine were asymptomatic and five were symptomatic. There were no deaths during follow-up (7.46+5.1 years). With respect to symptoms, the ≤3 s threshold had a low-positive predictive value (35.7%) and low sensitivity (26.3%), but good negative predictive value (86.7%) and specificity (91%). Conclusion: While the evidence is not incontrovertible, the 3 s pause threshold does not adequately discriminate between potentially asymptomatic and symptomatic competitive athletes, and alone should not be used to exclude potential competitors.

Original languageEnglish (US)
Pages (from-to)1873-1879
Number of pages7
Issue number12
StatePublished - Dec 1 2016

Bibliographical note

Publisher Copyright:
© The Author 2016.

Copyright 2017 Elsevier B.V., All rights reserved.


  • Athletes
  • Bradycardia
  • Cardiac
  • Pause
  • Sports
  • Symptoms


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