Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-24T13:06:24.488Z Has data issue: false hasContentIssue false
  • English
  • Français

Return to play in the athlete with cardiac disease: who decides and what is the protocol?

Published online by Cambridge University Press:  13 January 2017

Michael J. Silka
Michael J. Silka*
Affiliation:
Division of Cardiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
*
Correspondence to: M. J. Silka, MD, Division of Cardiology, Children’s Hospital Los Angeles, 4650 Sunset Blvd; MS #34, Los Angeles, CA 90027, United States of America. Tel: 323 361 2405; Fax: 323-361-1513; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Improved public awareness and advances in medical diagnostics have resulted in the development of criteria to determine eligibility or disqualification for the athlete with cardiovascular abnormalities. Simultaneously, protocols have been developed for athletes with concussion or orthopaedic injuries to guide team physicians and consultants in return-to-play decisions. However, there are currently inadequate data to allow the development of such protocols for athletes with cardiovascular abnormalities who have undergone treatment. Further complicating the decision process is the designation of the team physician as the ultimate authority in making return-to-play decisions – where the team physician often is an employee of the team and supports the team’s goal and players as well as the individual athlete. This review will discuss the ethical dilemma of the team physician and the role of the cardiovascular consultant. Following this, current data and practices regarding return to play will be discussed for the following conditions or diagnoses: following catheter ablation for supraventricular tachycardia; following pacemaker or implantable cardioverter-defibrillator implantation; unexplained syncope; and the athlete with a genetic mutation in the absence of any phenotype of associated disease. These recommendations will undoubtedly continue to evolve and improve and should be considered at this time as a point of departure.

Keywords

Return to playsudden cardiac deathathletic competitionsports competition
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Supplement S1: Sudden Cardiac Arrest in the Young: A Contemporary Perspective , January 2017 , pp. S110 - S114
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Maron, BJ, Zipes, DP, Kovacs, RJ. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: preamble, principles and general considerations. J Am Coll Cardiol 2015; 66: 2250–2255.Google Scholar
2. Lampert, R, Cannom, D. Sports participation for athletes with implantable cardioverter-defibrillators should be an individualized risk-benefit decision. Heart Rhythm 2008; 5: 861–863.Google Scholar
3. Oliveira, LPJ, Lawless, CE. Making prudent recommendations for return to play in adult athletes with cardiac conditions. Curr Sports Med Rep 2011; 10: 65–77.Google Scholar
4. Mitten, MJ, Zipes, DP, Maron, BJ, Bryant, WJ. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: legal aspects of medical eligibility and disqualification recommendations. J Am Coll Cardiol 2015; 66: 2447–2450.CrossRefGoogle ScholarPubMed
5. Maron, BJ, Mitten, MJ, Quandt, EF, Zipes, DP. Competitive athletes with cardiovascular disease: the case of Nicholas Knapp. N Engl J Med 1998; 339: 1632–1635.CrossRefGoogle ScholarPubMed
6. Mobley v Madison Square Garden LP, 2013 US Dist LEXIS (SD New York 2012).Google Scholar
7. Kroshus, E, Baugh, CM, Daneshvar, DH, Stamm, JM, Laursen, RM, Austin, SB. Pressure on sports medicine clinicians to prematurely return collegiate athletes to play after concussion. J Athl Train 2015; 50: 944–951.Google Scholar
8. Testioni, D, Hornik, CP, Smith, PB, Benjamin, DK, McKinney, RE. Sports medicine and ethics. Am J Bioeth 2013; 13: 4–12.Google Scholar
9. Parsons JT. 2014-2015 NCAA Sports Medicine Handbook, 2014. Retrieved 16 April 2016 from https://www.ncaapublications.com/p-4374-2013-14-ncaa-sports-medicine-handbook.aspx.Google Scholar
10. Granquist, MD, Podlog, L, Engel, JR, Newland, A. Certified athletic trainers’ perspective on rehabilitation adherence in collegiate athletic training settings. J Sport Rehabil 2014; 23: 123–133.Google Scholar
11. Moser, RS, Schatz, P, Lichtenstein, JD. The importance of proper administration and interpretation of neuropsychological baseline and postconcussion computerized testing. Appl Neuropsychol Child 2015; 4: 41–48.CrossRefGoogle ScholarPubMed
12. Panhuyzen-Goedkoop, NM, Smeets, JLR. Legal responsibilities of physicians when making decisions in athletes with cardiac disorders: Do guidelines provide sold legal footing? Br J Sports Med 2014; 48: 1193–1195.CrossRefGoogle Scholar
13. Pellicia, A, Fagard, R, Bjornstad, HH, et al. Recommendations for competitive sports participation in athletes with cardiovascular disease. Eur Heart J 2005; 26: 1422–1445.Google Scholar
14. Zipes, DP, Ackerman, MJ, Estes, NAM, Grant, AO, Myerburg, RJ, VanHare, G. Task Force 7: Arrhythmias. 36th Bethesda Conference. Eligibility recommendations for athletes with cardiovascular abnormalities. J Am Coll Cardiol 2005; 45: 1354–1363.Google Scholar
15. Zipes, DP, Link, MS, Ackerman, MJ, Kovacs, RJ, Myerburg, RJ, Estes, NAM. Eligibility and disqualification for competitive athletes with cardiovascular abnormalities. Task force 9: arrhythmias and conduction defects. J Am Coll Cardiol 2015; 66: 2412–2423.Google Scholar
16. Heidbucchel, H, Panhuyzen-Goedkoop, N, Corrado, D, et al. Recommendations for participation in leisure-time physical activities and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions. Part 1: supraventricular arrhythmias and pacemakers. Eur J Card Prevent and Rehab 2006; 13: 475–484.Google Scholar
17. Gajewski, KK, Reed, JH, Pilcher, TA, et al. Activity recommendations in paced pediatric patients. Wide variations among practitioners. Heart Rhythm 2008; 5: S95.Google Scholar
18. National Heart, Lung, and Blood Institute. Implantable cardioverter defibrillator. 2016. Retrieved February 13, 2016, from http://www.nhlbi.nih.gov/health/dci/Diseases/icd/icd_all.html.Google Scholar
19. Ackerman, MJ, Zipes, DP, Kovacs, RJ, Maron, BJ. Eligibility and disqualification for competitive athletes with cardiovascular abnormalities. Task force 10: the cardiac channelopathies. J Am Coll Cardiol 2015; 66: 2424–2428.Google Scholar
20. Hudson, KL, Holohan, MK, Collins, FS. Keeping pace with the times – the Genetic Information Nondiscrimination Act of 2008. N Engl J Med 2008; 358: 2661–2663.Google Scholar
21. Courson, R. Preventing sudden death on the athletic field: the emergency action plan. Curr Sports Med Rep 2007; 6: 93–100.Google Scholar