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Cardiovascular remodelling in the conditioned athlete is frequently associated with physiological ECG changes. Abnormalities, however, may be detected which represent expression of an underlying heart disease that puts the athlete at risk of arrhythmic cardiac arrest during sports. It is mandatory that ECG changes resulting from intensive physical training are distinguished from abnormalities which reflect a potential cardiac pathology. The present article represents the consensus statement of an international panel of cardiologists and sports medical physicians with expertise in the fields of electrocardiography, imaging, inherited cardiovascular disease, cardiovascular pathology, and management of young competitive athletes. The document provides cardiologists and sports medical physicians with a modern approach to correct interpretation of 12-lead ECG in the athlete and emerging understanding of incomplete penetrance of inherited cardiovascular disease. When the ECG of an athlete is examined, the main objective is to distinguish between physiological patterns that should cause no alarm and those that require action and/or additional testing to exclude (or confirm) the suspicion of an underlying cardiovascular condition carrying the risk of sudden death during sports. The aim of the present position paper is to provide a framework for this distinction. For every ECG abnormality, the document focuses on the ensuing clinical work-up required for differential diagnosis and clinical assessment. When appropriate the referral options for risk stratification and cardiovascular management of the athlete are briefly addressed.

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The original designation of "Arrhythmogenic right ventricular (dysplasia/) cardiomyopathy"(ARVC) was used by the scientists who first discovered the disease, in the pre-genetic and pre-cardiac magnetic resonance era, to describe a new heart muscle disease predominantly affecting the right ventricle, whose cardinal clinical manifestation was the occurrence of malignant ventricular arrhythmias. Subsequently, autopsy investigations, genotypephenotype correlations studies and the increasing use of contrast-enhancement cardiac magnetic resonance showed that the fibro-fatty replacement of the myocardium represents the distinctive phenotypic feature of the disease that affects the myocardium of both ventricles, with left ventricular involvement which may parallel or exceed the severity of right ventricular involvement. This has led to the new designation of "Arrhythmogenic Cardiomyopathy" (ACM), that represents the evolution of the original term of ARVC. The present International Expert Consensus document proposes an upgrade of the criteria for diagnosis of the entire spectrum of the phenotypic variants of ACM. The proposed "Padua criteria" derive from the diagnostic approach to ACM, which has been developed over 30 years by the multidisciplinary team of basic researchers and clinical cardiologists of the Medical School of the University of Padua. The Padua criteria are a working framework to improve the diagnosis of ACM by introducing new diagnostic criteria regarding tissue characterization findings by contrast-enhanced cardiac magnetic resonance, depolarization/repolarization ECG abnormalities and ventricular arrhythmia features for diagnosis of the left ventricular phenotype. The proposed diagnostic criteria need to be further validated by future clinical studies in large cohorts of patients.

Рабочая группа по диагностике и лечению гипертрофической кардиомиопатии Европейского общества кардиологов (ESC)Авторы/члены рабочей группы: perry M. Elliott* (Председатель) (великобритания) Aris Anastasakis (Греция), Michael A. borger (Германия), Martin borggrefe (Германия), Franco Cecchi (Италия), philippe Charron (Франция), Albert Alain Hagege (Франция), Antoine Lafont (Франция), Giuseppe Limongelli (Италия), Heiko Mahrholdt (Германия), William J. McKenna (великобритания), Jens Mogensen (дания), petros Nihoyannopoulos (великобритания), Stefano Nistri (Италия), petronella G. pieper (Нидерланды), burkert pieske (Австрия), Claudio Rapezzi (Италия), Frans H. Rutten (Нидерланды), Christoph Tillmanns (Германия), Hugh Watkins (великобритания). Дополнительный участник: Constantinos O'Mahony (великобритания).Комитет ESC по подготовке практических рекомендаций (КПР): Jose Luis Zamorano (Председатель) (Испания), Stephan Achenbach (Германия), Helmut baumgartner (Германия), Jeroen J. bax (Нидерланды), Héctor bueno (Испания), Veronica Dean (Франция), Christi Deaton (великобритания), Çetin Erol (Турция), Robert Fagard (Бельгия), Roberto Ferrari (Италия), David Hasdai (Израиль), Arno W. Hoes (Нидерланды), paulus Kirchhof (Германия/великобритания), Juhani Knuuti (Финляндия), philippe Kolh (Бельгия), patrizio Lancellotti (Бельгия), Ales Linhart (Чехия), petros Nihoyannopoulos (великобритания), Massimo F. piepoli (Италия), piotr ponikowski (Польша), per Anton Sirnes (Норвегия), Juan Luis Tamargo (Испания), Michal Tendera (Польша), Adam Torbicki (Польша), William Wijns (Бельгия), Stephan Windecker (Швейцария).Рецензенты: David Hasdai (Израиль) (КПР координатор рецензирования), piotr ponikowski (Польша) (КПР координатор рецензирования), Stephan Achenbach (Германия), Fernando Alfonso (Испания), Cristina basso (Италия), Nuno Miguel Cardim (Португалия), Juan Ramón Gimeno (Испания), Stephane Heymans (Нидерланды), per Johan Holm (Швеция), Andre Keren(Израиль), paulus Kirchhof (Германия/великобритания), philippe Kolh (Бельгия), Christos Lionis (Греция), Claudio Muneretto (Италия), Silvia priori (Италия), Maria Jesus Salvador (Испания), Christian Wolpert (Германия), Jose Luis Zamorano (Испания).Формы раскрытия конфликта интересов авторов и рецензентов рекомендаций доступны на сайте ESC www.escardio.org/guidelines

The 1996 American Heart Association consensus panel recommendations stated that pre-participation cardiovascular screening for young competitive athletes is justifiable and compelling on ethical, legal, and medical grounds. The present article represents the consensus statement of the Study Group on Sports Cardiology of the Working Group on Cardiac Rehabilitation and Exercise Physiology and the Working Group on Myocardial and Pericardial diseases of the European Society of Cardiology, which comprises cardiovascular specialists and other physicians from different European countries with extensive clinical experience with young competitive athletes, as well as with pathological substrates of sudden death. The document takes note of the 25-year Italian experience on systematic pre-participation screening of competitive athletes and focuses on relevant issues, mostly regarding the relative risk, causes, and prevalence of sudden death in athletes; the efficacy, feasibility, and cost-effectiveness of population-based pre-participation cardiovascular screening; the key role of 12-lead ECG for identification of cardiovascular diseases such as cardiomyopathies and channelopathies at risk of sudden death during sports; and the potential of preventing fatal events. The main purpose of the consensus document is to reinforce the principle of the need for pre-participation medical clearance of all young athletes involved in organized sports programmes, on the basis of (i) the proven efficacy of systematic screening by 12-lead ECG (in addition to history and physical examination) to identify hypertrophic cardiomyopathy-the leading cause of sports-related sudden death-and to prevent athletic field fatalities; (ii) the potential screening ability in detecting other lethal cardiovascular diseases presenting with ECG abnormalities. The consensus document recommends the implementation of a common European screening protocol essentially based on 12-lead ECG.

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AF is common in HCM and associated with high thromboembolic risk. LA dimension and age are independently associated with AF but the literature is insufficient to create robust clinical tools to predict AF or thromboembolism. Most data suggest that AF patients should be anticoagulated.