Amateur Athlete with Sinus Arrest and Severe Bradycardia Diagnosed through a Heart Rate Monitor: A Six-Year Observation-The Necessity of Shared Decision-Making in Heart Rhythm Therapy Management

Heart rate monitors (HRMs) are used by millions of athletes worldwide to monitor exercise intensity and heart rate (HR) during training. This case report presents a 34-year-old male amateur soccer player with severe bradycardia who accidentally identified numerous pauses of over 4 s (maximum length: 7.3 s) during sleep on his own HRM with a heart rate variability (HRV) function. Simultaneous HRM and Holter ECG recordings were performed in an outpatient clinic, finding consistent 6.3 s sinus arrests (SA) with bradycardia of 33 beats/min. During the patient's hospitalization for a transient ischemic attack, the longest pauses on the Holter ECG were recorded, and he was suggested to undergo pacemaker implantation. He then reduced the volume/intensity of exercise for 4 years. Afterward, he spent 2 years without any regular training due to depression. After these 6 years, another Holter ECG test was performed in our center, not confirming the aforementioned disturbances and showing a tendency to tachycardia. The significant SA was resolved after a period of detraining. The case indicates that considering invasive therapy was unreasonable, and patient-centered care and shared decision-making play a key role in cardiac pacing therapy. In addition, some sports HRM with an HRV function can help diagnose bradyarrhythmia, both in professional and amateur athletes.