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Is it time to loosen the restrictions on athletes with cardiac disorders competing in sport?
  1. Rui Providência1,
  2. Carina Teixeira2,
  3. Oliver Segal1,
  4. Augustus Ullstein3,
  5. Kim T Mueser2,
  6. Pier Lambiase1
  1. 1 Barts Heart Centre, Cardiac Electrophysiology Department, St. Bartholomew's Hospital, Barts NHS Trust, London, UK
  2. 2 Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA
  3. 3 Thirty Nine Essex Street LLP, London, UK
  1. Correspondence to Dr Rui Providência, Barts Heart Centre, Cardiac Electrophysiology Department, St. Bartholomew's Hospital, Barts NHS Trust, West Smithfield, London EC1A 7BE, UK; rui_providencia{at}yahoo.com

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Sudden cardiac death (SCD) in young athletes is a rare and dramatic event. Initial consensus guidelines from 2005 recommend restriction from competitive sports for all athletes with hereditary cardiomyopathies and channelopathies, with very minor exceptions.1

The field has changed: new data support a new approach

After decades of a conservative sports cardiology approach, recent findings call these universal restrictions into question. First, data on the use of automatic external defibrillators (AEDs) for witnessed sudden cardiac arrest (SCA) in sports have been reassuring.2 When SCA is properly recognised and an AED immediately available, survival from SCA during sport is largely possible.

Second, two reports, one focusing on long QT syndrome in athletes,3 and another on catecholaminergic ventricular tachycardia,4 have suggested that the risk of competition may be acceptable if athletes are well-informed and fully compliant with therapy. A recent task force of the American Heart Association and American College of Cardiology has suggested that competitive sports practice may be permissible in some athletes with channelopathies, assuming that appropriate precautionary measures are in place. Specifically, avoidance of exacerbating drugs, avoidance of dehydration, appropriate electrolyte replenishment (with drinks containing Mg2+ and K+) and establishment of an emergency action plan with staff trained in cardiopulmonary resuscitation and access to an AED.5

Third, in a recently analysis of 184 consecutive deaths in patients with hypertrophic cardiomyopathy referred to a single cardiac pathology …

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