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Heidbüchel H, Corrado D, Biffi A, Hoffmann E, Panhuyzen-Goedkoop N, Hoogsteen J, Delise P, Hoff PI, Pelliccia A. Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part II: ventricular arrhythmias, channelopathies and implantable defibrillators. ACTA ACUST UNITED AC 2007; 13:676-86. [PMID: 17001205 DOI: 10.1097/01.hjr.0000239465.26132.29] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This consensus paper on behalf of the Study Group on Sports Cardiology of the European Society of Cardiology follows a previous one on guidelines for sports participation in competitive and recreational athletes with supraventricular arrhythmias and pacemakers. The question of imminent life-threatening arrhythmias is especially relevant when some form of ventricular rhythm disorder is documented, or when the patient is diagnosed to have inherited a pro-arrhythmogenic disorder. Frequent ventricular premature beats or nonsustained ventricular tachycardia may be a hallmark of underlying pathology and increased risk. Their finding should prompt a thorough cardiac evaluation, including both imaging modalities and electrophysiological techniques. This should allow distinguishing idiopathic rhythm disorders from underlying disease that carries a more ominous prognosis. Recommendations on sports participation in inherited arrhythmogenic conditions and asymptomatic gene carriers are also discussed: congenital and acquired long QT syndrome, short QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, arrhythmogenic right ventricular cardiomyopathy and other familial electrical disease of unknown origin. If an implantable cardioverter defibrillator is indicated, it is no substitute for the guidelines relating to the underlying pathology. Moreover, some particular recommendations for patients/athletes with an implantable cardioverter defibrillator are to be observed.
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Affiliation(s)
- Hein Heidbüchel
- Cardiology-Electrophysiology, University Hospital Gasthuisberg, Leuven, Belgium.
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Abstract
Young athletes are disproportionately plagued with congenital cardiac disease. Many of these diseases predispose to sudden cardiac death (SCD), a dramatic and tragic outcome for any young athlete. In many cases, conditions that predispose to SCD do not cause symptoms or show signs on examination, making diagnosis of cardiac disease and prevention of SCD difficult. Clinicians should be familiar with common causes of SCD and their symptoms, perform careful evaluations, refer athletes in whom there are concerns, and make sure any concerning findings receive thorough evaluation. Clinicians should also be familiar with and follow recent guidelines on return to play. Unfortunately, most preparticipation examinations are inadequate, due in part to use of inadequate forms. Better forms are available and should replace inadequate ones.
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Affiliation(s)
- Susan Cochella
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA.
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Maron BJ, Pelliccia A. The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation 2006; 114:1633-44. [PMID: 17030703 DOI: 10.1161/circulationaha.106.613562] [Citation(s) in RCA: 434] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Barry J Maron
- The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, 920 East 28th St, Suite 60, Minneapolis, MN 55407, USA.
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54
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Abstract
All patients with hypertrophic cardiomyopathy (HCM) should have five aspects of care addressed. An attempt should be made to detect the presence or absence of risk factors for sudden arrhythmic death. If the patient appears to be at high risk, discussion of the benefits and risks of ICD are indicated, and many such patients will be implanted. Symptoms are appraised and treated. Bacterial endocarditis prophylaxis is recommended. Patients are advised to avoid athletic competition and extremes of physical exertion. First degree family members should be screened with echocardiography and ECG.
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Affiliation(s)
- Mark V Sherrid
- Hypertrophic Cardiomyopathy Program and Echocardiography Laboratory, Department of Medicine, Division of Cardiology, St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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MESH Headings
- AMP-Activated Protein Kinases
- Adrenergic beta-Antagonists/therapeutic use
- Adult
- Amino Acid Substitution
- Calcium Channel Blockers/therapeutic use
- Cardiomyopathy, Hypertrophic, Familial/diagnosis
- Cardiomyopathy, Hypertrophic, Familial/genetics
- Cardiomyopathy, Hypertrophic, Familial/pathology
- Cardiomyopathy, Hypertrophic, Familial/therapy
- Codon/genetics
- Death, Sudden, Cardiac/etiology
- Defibrillators, Implantable
- Energy Metabolism/genetics
- Female
- Genes, Dominant
- Genetic Heterogeneity
- Genetic Predisposition to Disease
- Genetic Testing
- Humans
- Hypertrophy, Left Ventricular/epidemiology
- Hypertrophy, Left Ventricular/etiology
- Lysosomal-Associated Membrane Protein 2
- Lysosomal Membrane Proteins/genetics
- Male
- Multienzyme Complexes/genetics
- Muscle Proteins/deficiency
- Muscle Proteins/genetics
- Mutation, Missense
- Pedigree
- Phenotype
- Protein Serine-Threonine Kinases/genetics
- Sarcomeres/chemistry
- Sarcomeres/pathology
- Troponin T/genetics
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Affiliation(s)
- Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
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56
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Lampert R, Cannom D, Olshansky B. Safety of Sports Participation in Patients with Implantable Cardioverter Defibrillators: A Survey of Heart Rhythm Society Members. J Cardiovasc Electrophysiol 2006; 17:11-5. [PMID: 16426392 DOI: 10.1111/j.1540-8167.2005.00331.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED Safety of Sports for ICD Patients. INTRODUCTION The safety of sports participation for patients with implantable cardioverter defibrillators (ICDs) is unknown, and recommendations among physicians may vary widely. The purposes of this study were to determine current practice among patients with ICDs and their physicians regarding sports participation, and to determine how many physicians have cared for patients who have sustained adverse events during sports participation. METHODS AND RESULTS A survey was mailed to all 1,687 U.S. physician members of the Heart Rhythm Society. Among 614 respondent physicians, recommendations varied widely. Only 10% recommended avoidance of all sports more vigorous than golf. Seventy-six percent recommended avoidance of contact, and 45% recommend avoidance of competitive sports. Most (71%) based restrictions on patients' underlying heart disease. Regardless of recommendations, most physicians (71%) reported caring for patients who participated in sports, including many citing vigorous, competitive sports, most commonly cited were basketball, running, and skiing. ICD shocks during sports were common, cited by 40% of physicians. However, few adverse consequences were reported. One percent of physicians reported known injury to patient (all but 3 minor); 5%, injury to the ICD system, and <1%, failure of shocks to terminate arrhythmia. The most common adverse event reported was lead damage attributed to repetitive-motion activities, most commonly weightlifting and golf. CONCLUSIONS Physician recommendations for sports participation for patients with ICDs varies widely. Many patients with ICDs do participate in vigorous and even competitive sports. While shocks were common, significant adverse events were rare.
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Affiliation(s)
- Rachel Lampert
- Yale University School of Medicine, Department of Medicine, New Haven, Connecticut 06520, USA.
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58
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Mitten MJ, Maron BJ, Zipes DP. Task Force 12: Legal aspects of the 36th Bethesda Conference recommendations. J Am Coll Cardiol 2005; 45:1373-5. [PMID: 15837292 DOI: 10.1016/j.jacc.2005.02.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Maron BJ, Ackerman MJ, Nishimura RA, Pyeritz RE, Towbin JA, Udelson JE. Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome. J Am Coll Cardiol 2005; 45:1340-5. [PMID: 15837284 DOI: 10.1016/j.jacc.2005.02.011] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Maron BJ, Zipes DP. Introduction: Eligibility recommendations for competitive athletes with cardiovascular abnormalities—general considerations. J Am Coll Cardiol 2005; 45:1318-21. [PMID: 15837280 DOI: 10.1016/j.jacc.2005.02.006] [Citation(s) in RCA: 358] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Maron BJ, Chaitman BR, Ackerman MJ, Bayés de Luna A, Corrado D, Crosson JE, Deal BJ, Driscoll DJ, Estes NAM, Araújo CGS, Liang DH, Mitten MJ, Myerburg RJ, Pelliccia A, Thompson PD, Towbin JA, Van Camp SP. Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation 2004; 109:2807-16. [PMID: 15184297 DOI: 10.1161/01.cir.0000128363.85581.e1] [Citation(s) in RCA: 333] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A group of relatively uncommon but important genetic cardiovascular diseases (GCVDs) are associated with increased risk for sudden cardiac death during exercise, including hypertrophic cardiomyopathy, long-QT syndrome, Marfan syndrome, and arrhythmogenic right ventricular cardiomyopathy. These conditions, characterized by diverse phenotypic expression and genetic substrates, account for a substantial proportion of unexpected and usually arrhythmia-based fatal events during adolescence and young adulthood. Guidelines are in place governing eligibility and disqualification criteria for competitive athletes with these GCVDs (eg, Bethesda Conference No. 26 and its update as Bethesda Conference No. 36 in 2005). However, similar systematic recommendations for the much larger population of patients with GCVD who are not trained athletes, but nevertheless wish to participate in any of a variety of recreational physical activities and sports, have not been available. The practicing clinician is frequently confronted with the dilemma of designing noncompetitive exercise programs for athletes with GCVD after disqualification from competition, as well as for those patients with such conditions who do not aspire to organized sports. Indeed, many asymptomatic (or mildly symptomatic) patients with GCVD desire a physically active lifestyle with participation in recreational and leisure-time activities to take advantage of the many documented benefits of exercise. However, to date, no reference document has been available for ascertaining which types of physical activity could be regarded as either prudent or inadvisable in these subgroups of patients. Therefore, given this clear and present need, this American Heart Association consensus document was constituted, based largely on the experience and insights of the expert panel, to offer recommendations governing recreational exercise for patients with known GCVDs.
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Abstract
Cardiovascular disease (CVD) is the leading cause of death in the United States, resulting in increased awareness of the preventive importance of regular physical activity. Because athletes are considered physically fit, occurrence of sudden athlete death from CVD is perplexing. Regular intense physical activity can cause changes to the cardiovascular system that mimic known CVD processes. Therefore, screening of athletes for conditions that may increase risk for sudden cardiac death (SCD) is challenging. This article focuses on this problem, discussing the athlete's heart, SCD and associated CV conditions, and preparticipation screening. We also review recommendations of the 26th Bethesda Conference on determining eligibility for competition in athletes with known CV abnormalities, and how the recommendations relate to individual disease processes.
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Affiliation(s)
- Chandrasekhar R Vasamreddy
- Division of Cardiology, The Johns Hopkins Hospital, Blalock 524C-Cardiology, The Johns Hopkins Ciccarone Preventive Cardiology Center, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Abstract
Young competitive athletes are perceived by the general population to be the healthiest members of society. The possibility that highly trained high school and college athletes may have a potentially serious cardiac condition that can predispose to life-threatening dysrhythmias or sudden cardiac death (SCD) seems paradoxical. The occurrence of SCD in young athletes from dysrhythmias is an uncommon but highly visible event. Media reports of sudden death in athletes have intensified the public and medical interest in medical, ethical, and legal issues related to cardiac disorders in the athlete. Developing screening strategies to identify conditions associated with sudden death has been the focus of attention of experts in the fields of arrhythmology and sports medicine and has resulted in Consensus Statements and Guidelines for evaluation of athletes. These guidelines provide information and recommendations for detection, evaluation, and management of athletes with cardiovascular disorders and criteria for eligibility and disqualification from participation in high-intensity and competitive sports. Differentiating normal exercise-induced physiologic changes in the heart from pathological conditions associated with sudden death is critical for developing screening strategies to identify athletes at high risk. This article discusses a case report of sudden cardiac death in an athlete followed by a brief review of various causes of cardiac dysrhythmias in young athletes and recommendations for screening and management of athletes with cardiovascular diseases.
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MESH Headings
- Adolescent
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/genetics
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Electric Countershock/instrumentation
- Genetic Testing
- Humans
- Hypertrophy, Left Ventricular/etiology
- Male
- Sports
- Ventricular Fibrillation/etiology
- Ventricular Myosins/genetics
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64
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Affiliation(s)
- Barry J Maron
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA.
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65
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Abstract
Though initially challenging, the process of determining appropriate levels of exercise for patients with congenital heart disease can be broken down into several practical steps: List 1: Summary of approach to CHD patients and exercise Get the records: Surgical reports, diagnostic test results, office visits, admissions [table: see text] Obtain family history: Family members with sudden death increase risk. Thorough physical exam: Special attention to auscultation of murmurs Appropriate diagnostic testing: Noninvasive testing is usually adequate. Review guidelines: 26th Bethesda Conference, 1994 [13] Make recommendation: Be specific about types of exercise allowed. Reassess at least annually: Patients' status may change over time [24]. The use of this algorithm and review of available guidelines, in combination with selected consultation with other specialists, should allow the sports physician to prescribe exercise for the majority of these patients confidently. Examples of several congenital defects of varying severity, and the appropriate exercise prescription, are listed in Table 1.
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Affiliation(s)
- John M Dent
- Adult Echocardiography and Exercise Stress Laboratories, University of Virginia Health System, Box 800662, Charlottesville, VA 22908, USA.
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66
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Affiliation(s)
- R Roberts
- Section of Cardiology, Baylor College of Medicine, Houston, TX 77030, USA.
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67
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Souza ECMSD, Leite N, Radominski RB, Rodriguez-Añez CR, Correia MRH, Omeiri S. Reabilitação cardiovascular: custo-benefício. REV BRAS MED ESPORTE 2000. [DOI: 10.1590/s1517-86922000000400006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kinoshita N, Mimura J, Obayashi C, Katsukawa F, Onishi S, Yamazaki H. Aortic root dilatation among young competitive athletes: echocardiographic screening of 1929 athletes between 15 and 34 years of age. Am Heart J 2000; 139:723-8. [PMID: 10740158 DOI: 10.1016/s0002-8703(00)90055-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Aortic dilatation can be lethal for young competitive athletes. The prevalence among athletes is not known, however, and thus a reasonable approach to early recognition remains uncertain. METHODS AND RESULTS Echocardiograms of 1929 normotensive athletes 15 to 34 years of age were analyzed. Five (0.26%) athletes had aortic dilatation; 4 of the 5 played basketball. This made the prevalence of aortic dilatation 0.96% (4 of 415) among basketball and volleyball players, who represented a population of especially tall athletes. Tallness aside, only 2 of the 5 athletes had features of Marfan syndrome. Among the athletes without aortic dilatation, the relation between body surface area and aortic root dimension was nonlinear and best described with a quadratic regression model. Athletes with aortic dilatation fell well outside the 95% confidence interval. CONCLUSION Because a higher incidence of aortic dilatation is to be anticipated among very tall athletes, inclusion of echocardiography in screening before participation in certain sports should be considered.
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Affiliation(s)
- N Kinoshita
- Sports Medicine Research Center, Keio University, Japan.
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69
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Brown JM, Mehler PS, Harris RH. Medical complications occurring in adolescents with anorexia nervosa. West J Med 2000; 172:189-93. [PMID: 10734811 PMCID: PMC1070803 DOI: 10.1136/ewjm.172.3.189] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- J M Brown
- Denver Health Medical Center, Division of Pediatrics, CO 80204, USA
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