Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Preamble, Principles, and General Considerations

Maron, Barry J.; Zipes, Douglas P.; Kovacs, Richard J.

doi:10.1161/cir.0000000000000236

Cited by 122 publications

(73 citation statements)

References 19 publications

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“…Introduced specific criteria for evaluation of rSr' QRS morphology in leads V1-V2 may facilitate patient management [16]. Importantly, asymptomatic athletes with RBBB or left bundle branch block who do not develop type II second-degree AVB or complete AVB, with no heart disease that precludes participation, can participate in competitive athletics [17].…”

Section: Discussionmentioning

confidence: 99%

Exercise ECG unmasked Brugada sign: manifestation of the risk of sports-associated sudden cardiac arrest (RCD code: V-1A.1)

Matusik

Komar

Podolec

et al. 2017

Journal of Rare Cardiovascular Diseases

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Sports-associated sudden cardiac arrest (SCA) constitutes an important problem. Causes of SCA during sport activities include Brugada syndrome (BrS) among others. We describe a 29-year-old male, without a history of cardiovascular disease, who suffered from SCA during football training and despite intensive treatment, after almost 4 weeks of hospitalization, unfortunately died. Detailed medical documentation review showed grade I atrioventricular block, intraventricular conduction abnormalities and BrS type 2 morphology of ST-segment elevation on resting 12-lead electrocardiogram (ECG). The patient had a history of syncope during physical activity. Further echocardiographic study did not reveal significant structural heart disease. Submaximal exercise testing was performed and showed ventricular extrasystoles during physical activity and type 1 BrS morphology of ST-segment elevation during recovery phase. We compared observed ECG changes to those present in a healthy football player and described noticeable similarities. Exercise ECG testing, especially in patients after syncope of probable arrhythmic etiology, may unmask BrS ECG pattern and lead to BrS diagnosis. JRCD 2017; 3 (3): 92-97

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Section: Discussionmentioning

confidence: 99%

Exercise ECG unmasked Brugada sign: manifestation of the risk of sports-associated sudden cardiac arrest (RCD code: V-1A.1)

Matusik

Komar

Podolec

et al. 2017

Journal of Rare Cardiovascular Diseases

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“…Most guideline committees are based in American organizations and societies and American physicians typically work in a much more litigious environment than elsewhere in the world. However, it is important to stress that the recommendations do allow physicians to exercise their medical judgment in individual cases [8]. The American scientific statement recommendations do not, per se, rigidly restrict clinical practice or medical decision-making.…”

Section: The Fear Of Disqualificationmentioning

confidence: 99%

Empowerment of athletes with cardiac disorders: a new paradigm

et al. 2017

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Athletes with cardiac disorders frequently pose an ethical and medical dilemma to physicians assessing their eligibility to participate in sport. In recent decades, patient empowerment has been gaining increasing recognition in clinical decision-making. Empowerment is a process through which people are involved over the decisions and actions that affect their own lives. In the context of a cardiac disorder, empowerment means giving an athlete the chance to participate in the decision about whether or not to remain active in competition. Three models of treatment decision-making are described in this paper, with progressive levels of empowerment: the paternalistic model (the athlete has a passive role), the shared-decision making model (both athlete and physician participate in the decision) and the informeddecision making (the decision is made by the athlete while the role of the physician is solely to provide information). This paper critically discusses the issues involved in disqualification of athletes with cardiovascular disorders and suggests possible ways of incorporating patient empowerment in potentially career-ending decisions. The authors propose a model of empowerment, which gives patients the opportunity to choose how much, and if, they would like to be involved in the decision-making process.

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“…2,7 In general, athletes are defined as those who participate in sports requiring intense systematic training and regular competition against others in an organized team or individual sport. 8,9 Young competitive athletes (aged <35 years) are widely regarded as a special subgroup of healthy individuals with a unique lifestyle, who are seemingly invulnerable and capable of extraordinary physical achievement. 9,10 Although the long-term overall benefit of regular exercise has been shown to reduce mortality due to cardiovascular events, the risk of an acute event is transiently increased during and immediately after acute, particularly vigorous, exercise.…”

Section: Introductionmentioning

confidence: 99%

“…8,9 Young competitive athletes (aged <35 years) are widely regarded as a special subgroup of healthy individuals with a unique lifestyle, who are seemingly invulnerable and capable of extraordinary physical achievement. 9,10 Although the long-term overall benefit of regular exercise has been shown to reduce mortality due to cardiovascular events, the risk of an acute event is transiently increased during and immediately after acute, particularly vigorous, exercise. 2,8,11 Athletes with syncope represent a unique challenge for the physician, as the potential causes range from benign neurally mediated episodes to underlying heart disease such as hypertrophic cardiomyopathy (HCM), which may be a harbinger of sudden cardiac death (SCD).…”

Section: Introductionmentioning

confidence: 99%

Syncope in the young athlete: Assessment of prognosis in subjects with hypertrophic cardiomyopathy

Magalhães-Ribeiro

Freitas

2016

Revista Portuguesa de Cardiologia

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Syncope is a common but concerning event in young athletes. Although mostly due to benign reflex causes, syncope may be arrhythmic and precede sudden cardiac death. Efforts must therefore be made to distinguish post-exertional syncope from syncope during exercise, which can be an ominous sign of a possible underlying heart disease, such as hypertrophic cardiomyopathy. Prevention requires cooperation between physician and athlete, in order to identify individuals at risk and to protect them from sudden death. Solving this diagnostic dilemma may lead to recommendations for athletes to be cleared to play or disqualified from competitive sports, and presents challenging and controversial decisions to the health care provider that can prove difficult to implement. Although exercise contributes to physical and psychological well-being, there are insufficient data to indicate whether an athlete with hypertrophic cardiomyopathy diagnosed after a syncopal episode can safely resume competitive physical activity. The purpose of this study was to review the literature on syncope in young athletes and its relationship to individuals with hypertrophic cardiomyopathy, in order to enable accurate assessment of prognosis and the possibility of resuming competitive sports.

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Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Preamble, Principles, and General Considerations

Cited by 122 publications

References 19 publications

Exercise ECG unmasked Brugada sign: manifestation of the risk of sports-associated sudden cardiac arrest (RCD code: V-1A.1)

Exercise ECG unmasked Brugada sign: manifestation of the risk of sports-associated sudden cardiac arrest (RCD code: V-1A.1)

Empowerment of athletes with cardiac disorders: a new paradigm

Syncope in the young athlete: Assessment of prognosis in subjects with hypertrophic cardiomyopathy

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