European Heart Journal Advance Access originally published online on May 27, 2005
European Heart Journal 2005 26(14):1422-1445; doi:10.1093/eurheartj/ehi325
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org
Recommendations for competitive sports participation in athletes with cardiovascular disease
A consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology
Experts who contributed to and revised parts of these recommendations:,
1National Institute of Sports Medicine, Italian National Olympic Committee, Via dei Campi Sportivi 46, 00197 Rome, Italy
2Cardiovascular Rehabilitation Unit, KU Leuven, Leuven, Belgium
3Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
4Division of Inherited Cardiovascular Diseases, University of Athens, Athens, Greece
5Department of Pathological Anatomy, University of Pavia, Pavia, Italy
6Department of Cardiology, University of Brescia, Brescia, Italy
7Department of Medicine, Sahlgrens University Hospital/Östra, Gothenburg, Sweden
8Unité Biologie et Medicine du Sport, Hopital Pontchavillon, Rennes, France
9Departments of Cardiology and Pathology, University of Padova, Padova, Italy
10Department of Cardiology, Civil Hospital, Conegliano, Italy
11Department of Cardiology, University Hospital, Munich, Germany
12University Hospital Gasthuisberg, Leuven, Belgium
13Department of Cardiology, Bad Oeynhausen, Germany
14Department of Cardiology, Nijmegen, The Netherlands
15Klinikk Ullevål Sykehus, Oslo, Norway
16Department of Cardiology, University Hospital Uppsala, Uppsala, Sweden
17Department of Sports Medicine, Aristotle University, Thessaloniki, Greece
18Wellness Medical Center, Stockport, UK
19Heart Institute, Sheba Medical Center, Tel Hashomer, Israel
20Division of Cardiology, University Hospital, Basel, Switzerland
21Children National Medical Center, Washington DC, USA
22Cardiac Rehabilitation Center, Bronovo Hospital, Gravenhage, The Netherlands
23Heart Hospital, University College London, London, UK
24Department of Cardiology, University of L'Aquila, L'Aquila, Italy
25Molecular Cardiology, Fondazione S. Maugeri, Pavia, Italy
26Department of Cardiology, Meander Medisch Centrum, Amersfoort, The Netherlands
Received 23 November 2004; revised 17 March 2005; accepted 7 April 2005; online publish-ahead-of-print 27 May 2005.
* Corresponding author. Tel: +39 6 3685 9127; fax: +39 06 36859256. E-mail address: ant.pelliccia@libero.it
This paper was guest edited by Prof. Hugo Saner, Inselspital, Kardiovaskulare Pravention & Rehabilitatiom, Schweizer Herz- und Gefasszentrum, Bern, Switzerland
| The first 150 words of the full text of this article appear below. |
Introduction
The rationale for offering an expert consensus document concerning the participation in competitive sports by individuals with cardiovascular (CV) disease is based on the widely accepted clinical perception, substantiated by scientific evidence,1 that athletes with underlying (even clinically silent) CV disease have an increased risk for sudden cardiac death (SCD) or clinical deterioration in comparison with normal individuals, by virtue of their regular exercise training and sports participation. Therefore, the aim of the present recommendations is to provide careful guidelines to physicians and consultant cardiologists regarding the evaluation of athletes with CV abnormalities and to suggest sports activities that can be safely performed. These recommendations assume that the cardiac diagnosis has already been made, so that the issues directly related to screening for CV disease2 are beyond the scope of this document.
Target of the recommendations
For the purpose of this document, the target of recommendations are competitive athletes, here defined as
Nature of the recommendations
Implementation of the recommendations within the European countries
Role of the examining physician
Search methodology
Classification of sports
Recommendations for participation in competitive sports in athletes with congenital heart disease
General considerations
Arrhythmias
Ventricular function
Pulmonary vascular resistance
Dysfunction of the valves
Conduits and mechanical valves
Functioning class
Abnormal exercise blood pressure response
Prophylaxis of endocarditis
Unrecognized CHD
Evaluation
Individualized supplementary investigations
Follow-up and re-evaluation
Conclusion
Recommendations
Recommendations for participation in competitive sports in athletes with acquired cardiac valve diseases
Mitral valve stenosis
Evaluation
Classification
Recommendations
Mitral valve regurgitation
Evaluation
Classification
Recommendations
Aortic valve stenosis
Evaluation
Classification
Recommendations
Aortic valve regurgitation
Evaluation
Classification
Recommendations
Tricuspid valve stenosis
Recommendations
Tricuspid valve regurgitation
Recommendations
Multi-valvular diseases
Recommendations
Post-operative patients with a prosthetic/bioprosthetic heart valve
Recommendations
Athletes post-valvuloplasty
Recommendations
Mitral valve prolapse
Evaluation
Recommendations
Prophylaxis against endocarditis
Recommendations for participation in competitive sports in athletes with cardiomyopathies, myocarditis, and pericarditis
Hypertrophic cardiomyopathy
Evaluation
12-Lead ECG
Echocardiography
Molecular genetics
Recommendations
Isolated abnormal ECGs
Dilated cardiomyopathy
Evaluation
Exercise testing and 24 h Holter monitoring
Echocardiography
Recommendations
Arrhythmogenic RV cardiomyopathy/dysplasia
Evaluation
Recommendations
Myocarditis
Evaluation
Recommendations
Pericarditis
Evaluation
Recommendations
Recommendations for sports participation in patients with Marfan's syndrome (MFS)
Evaluation
Recommendations
Recommendations for participation in competitive sports in athletes with systemic hypertension
Risk stratification
Evaluation
Recommendations
General recommendations
Choice of drugs
Recommendations for sports participation
Recommendations for participation in competitive sports in athletes with ischaemic heart disease (IHD)
Athletes with evidence of IHD
Evaluation
Risk stratification
Specific comments
Recommendations
Athletes without evidence of IHD, but with one or more risk factors for IHD
Evaluation
Recommendations
Recommendations for participation in competitive sports in athletes with arrhythmias and potentially arrhythmogenic conditions
General considerations
Sinus bradycardia
Recommendations
Atrioventricular blocks
Recommendations
Supraventricular premature beats and tachycardia
Supraventricular premature beats
Paroxysmal supraventricular tachycardia
Ventricular pre-excitation (Wolff–Parkinson–White Syndrome)
WPW and paroxysmal AV re-entry tachycardia
WPW and AF or flutter
Asymptomatic pre-excitation on ECG
Atrial fibrillation
Recommendations
Atrial flutter
Recommendations
Premature ventricular beats
Recommendations
Non-sustained ventricular tachycardia
Recommendations
Slow ventricular tachycardia (idio-ventricular accelerated rhythm)
Recommendations
Benign idiopathic ventricular tachycardia: fascicular ventricular tachycardia and RV outflow tachycardia
Recommendations
Malignant ventricular tachycardia
Symptoms of possible arrhythmic origin: syncope
Recommendations
Arrhythmogenic disorders: ion channel disease
Long QT syndrome
Brugada syndrome
Catecholaminergic ventricular tachycardia
Catheter ablation in athletes
Patients with PM
Recommendations
Patients with ICD
Recommendations
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