Top Things to Know: Eligibility and Disqualification Recommendations for Athletes with Cardiovascular Abnormalities

1. Young trained athletes with underlying cardiovascular abnormalities are likely at some increase in risk for sudden cardiac death (usually on the athletic field) compared to non-athletes or competitive athletes without cardiovascular disease.
2. These recommendations are not intended to address all forms of exercise, but rather is intended to address organized and sanctioned competitive sports participation, such as most commonly in middle school, high school and college, and not with purely recreational physical activities.
3. Inherited arrhythmia syndromes can impact very young individuals, and patients with congenital or acquired heart diseases now engage in competitive athletics at more advanced ages.
4. In the U.S. under age 35 years, genetic heart diseases predominate with hypertrophic cardiomyopathy (HCM) the most common, accounting for at least one-third of the mortality in autopsy-based athlete study populations.
5. Sudden death in young athletes occurs in both genders (more common in males, 9:1) and all ethnicities (though prominently African-Americans).
6. In most athletes, sudden death occurs in the setting of ventricular fibrillation, with the notable exception of aortic dilatation leading to dissection and rupture.
7. For older athletes >35 years of age, atherosclerotic coronary artery disease is the predominant cause of sudden death, but occurs less frequently in younger participants.
8. Nine of the Task Force topics are disease specific. Additional topics include: sport classification, pre-participation screening, emergency plans, legal aspects, and drugs and performance enhancing substances.
9. These scientific statements offer guidance to providers for decision-making related to temporary or permanent disqualification vs. eligibility in athletes with probable/conclusive evidence of cardiovascular disease.

References

1. Maron BJ, Zipes DP, Kovacs RJ; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: preamble, principles, and general considerations: a scientific statement from the American Heart Association and American College of Cardiology [published online ahead of print November 2, 2015]. Circulation. doi: 10.1161/CIR.0000000000000236.
2. Levine BD; Baggish AL, Kovacs RJ, Link MS, Maron MS, Mitchell JH; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 1: classification of sports: dynamic, static, and impact: a scientific statement from the American Heart Association and American College of Cardiology. Cardiology [published online ahead of print November 2, 2015]. Circulation. doi: 10.1161/CIR.0000000000000237.
3. Maron BJ, Levine BD, Washington RL, Baggish AL, Kovacs RJ, Maron MS; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 2: preparticipation screening for cardiovascular disease in competitive athletes: a scientific statement from the American Heart Association and American College of Cardiology [published online ahead of print November 2, 2015]. Circulation. doi: 10.1161/CIR.0000000000000238.
4. Maron BJ, Udelson JE, Bonow RO, Nishimura RA, Ackerman MJ, Estes NAM 3rd, Cooper LT Jr, Link MS, Maron MS; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 3: hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and other cardiomyopathies, and myocarditis: a scientific statement from the American Heart Association and American College of Cardiology [published online ahead of print November 2, 2015]. Circulation. doi: 10.1161/CIR.0000000000000239.
5. Van Hare GF, Ackerman MJ, Evangelista JK, Kovacs RJ, Myerburg RJ, Shafer KM, Warnes CA, Washington RL; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 4: congenital heart disease: a scientific statement from the American Heart Association and American College of Cardiology [published online ahead of print November 2, 2015]. Circulation. doi: 10.1161/CIR.0000000000000240.
6. Bonow RO, Nishimura RA, Thompson PD, Udelson JE; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 5: valvular heart disease: a scientific statement from the American Heart Association and American College of Cardiology [published online ahead of print November 2, 2015]. Circulation. doi: 10.1161/CIR.0000000000000241.
7. Black HR, Sica D, Ferdinand K, White WB; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 6: hypertension: a scientific statement from the American Heart Association and the American College of Cardiology [published online ahead of print November 2, 2015]. Circulation. doi: 10.1161/CIR.0000000000000242.
8. Braverman AC, Harris KM, Kovacs RJ, Maron BJ; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 7: aortic diseases, including Marfan syndrome: a scientific statement from the American Heart Association and American College of Cardiology. Circulation [published online ahead of print November 2, 2015]. Circulation. doi: 10.1161/CIR.0000000000000243.
9. Thompson PD, Myerburg RJ, Levine BD, Udelson JE, Kovacs RJ; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 8: coronary artery disease: a scientific statement from the American Heart Association and American College of Cardiology [published online ahead of print November 2, 2015]. Circulation. doi: 10.1161/CIR.0000000000000244.
10. Zipes DP, Link MS, Ackerman MJ, Kovacs RJ, Myerburg RJ, Estes NAM 3rd; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 9: arrhythmias and conduction defects: a scientific statement from the American Heart Association and American College of Cardiology [published online ahead of print November 2, 2015]. Circulation. doi: 10.1161/CIR.0000000000000245.
11. Ackerman MJ, Zipes DP, Kovacs RJ, Maron BJ; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 10: the cardiac channelopathies: a scientific statement from the American Heart Association and American College of Cardiology [published online ahead of print November 2, 2015]. Circulation. doi: 10.1161/CIR.0000000000000246.
12. Estes NAM 3rd, Kovacs RJ, Baggish AL, Myerburg RJ; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 11: drugs and performance-enhancing substances: a scientific statement from the American Heart Association and American College of Cardiology [published online ahead of print November 2, 2015]. Circulation. doi: 10.1161/CIR.0000000000000247.
13. Link MS, Myerburg RJ, Estes NAM 3rd; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 12: emergency action plans, resuscitation, cardiopulmonary resuscitation, and automated external defibrillators: a scientific statement from the American Heart Association and American College of Cardiology [published online ahead of print November 2, 2015]. Circulation. doi: 10.1161/CIR.0000000000000248.
14. Link MS, Estes NAM 3rd, Maron BJ; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 13: commotio cordis: a scientific statement from the American Heart Association and American College of Cardiology [published online ahead of print November 2, 2015]. Circulation. doi: 10.1161/CIR.0000000000000249.
15. Maron BJ, Harris KM, Thompson PD, Eichner ER, Steinberg MH; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 14: sickle cell trait: a scientific statement from the American Heart Association and American College of Cardiology [published online ahead of print November 2, 2015]. Circulation. doi: 10.1161/CIR.0000000000000250.
16. Mitten MJ, Zipes DP, Maron BJ, Bryant WJ; on behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology, Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and the American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 15: legal aspects of medical eligibility and disqualification recommendations: a scientific statement from the American Heart Association and American College of Cardiology [published online ahead of print November 2, 2015]. Circulation. doi: 10.1161/CIR.0000000000000251.