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 M Karim, Oana Dickinson, David G. Benditt

Research output: Contribution to journalReview articlepeer-review

21 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.


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


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