Review Article| Volume 41, ISSUE 1, P81-92, February 2023

Download started.


Devices and Athletics

Decision-Making Around Return to Play
Published:October 18, 2022DOI:


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Cardiology Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Harmon K.G.
        • Asif I.M.
        • Klossner D.
        • et al.
        Incidence of sudden cardiac death in National collegiate athletic association athletes.
        Circulation. 2011; 123: 1594-1600
        • Myerburg R.
        • Estes III, N.A.M.
        • Fontaine J.M.
        • et al.
        36th Bethesda conference: eligibility recommendations for competitive athletes with cardiovascular abnormalities - task force 10: automated external defibrillators.
        J Am Coll Cardiol. 2005; 45: 1369-1371
        • Corrado D.
        • Basso C.
        • Rizzoli G.
        • et al.
        Does sports activity enhance the risk of sudden death in adolescents and young adults?.
        J Am Coll Cardiol. 2003; 42: 1959-1963
      1. 2015 IoM. Strategies to improve cardiac arrest survival: a time to act. The National Academies Press, Washington, DC2015
        • Maron B.
        • Udelson J.E.
        • Bonow R.O.
        • et al.
        Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 3: hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and other cardiomyopathies, and myocarditis.
        Circulation. 2015; 132: e273-e280
        • Zipes D.
        • Link M.S.
        • Ackerman M.J.
        • et al.
        Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 9: arrhythmia and conduction defects: a scientific statement from the American heart association and American College of cardiology.
        Circulation. 2015; 132: e315-e325
        • McAllister D.
        • Motamedi A.R.
        • Hame S.L.
        • et al.
        Quality of life assessment in elite collegiate athletes.
        Am J Sports Med. 2001; 29: 806-810
        • Rahman B.
        • Macciocca I.
        • Sahhar M.
        • et al.
        Adolescents with implantable cardioverter defibrillators: a patient and parent Perspective.
        Pacing Clin Electrophysiol. 2012; 35: 62-72
        • Lampert R.
        • Cannom D.
        • Olshansky B.
        Safety of sports participation in patients with implantable cardioverter defibrillators: a survey of herat rhythm society members.
        J Cardiovasc Electrophysiol. 2006; 17: 11-15
        • Lampert R.
        • Olshansky B.
        • Heidbuchel H.
        • et al.
        Safety of sports for athletes with implantable cardioverter-defibrillators: results of a prospective, multinational registry.
        Circulation. 2013; 127: 2021-2030
        • Lampert R.
        • Olshansky B.
        • Heidbuchel H.
        • et al.
        Safety of sports for athletes with implantable cardioverter-defbrillators: long-term results of a prospective multinational registry.
        Circulation. 2017; 135: 2310-2312
        • Providencia R.
        • Kramer D.B.
        • Pimenta D.
        • et al.
        Transvenous implantable cardioverter-defibrillator (ICD) lead performance: a meta-analysis of Observational studies.
        J Am Heart Assoc. 2015; 4
        • Link M.
        • Sullivan R.M.
        • Olshansky B.
        • et al.
        Implantable cardioverter defibrillator lead survival in athletic patients.
        Circ Arrhythmia Electrophysiol. 2021; 14
      2. NCAA banned Substances. 2021 (Available at:) (Accessed March 3, 2022)
        • Saarel E.
        • Law I.
        • Berul C.I.
        • et al.
        Safety of sports for young patients with implantable cardioverter-defibrillators: long-term results of the multinational ICD sports registry.
        Circ Arrhythmia Electrophysiol. 2018; 11: e006305
        • Heidbuchel H.
        • Willems R.
        • Jordaens L.
        • et al.
        Intensive recreational athletes in the prospective multinational ICD Sports Safety Registry: results from the European cohort.
        Eur J Prev Cardiol. 2019; 26: 764-775
        • James C.
        • Bhonsale A.
        • Tichnell C.
        • et al.
        Exercise increases age-related Penetrance and arrhythmic risk in arrhthmogenic right ventricular dysplasia/cardiomyopathy associated desmosomal mutation carriers.
        J Am Coll Cardiol. 2013; 62
        • Ruwald A.-C.
        • Marcus F.
        • Estes III,
        • et al.
        Association of competitive and recreational sport participation with cardiac events in patients with arrhythmogenic right ventricular cardiomyopathy: results from the North American multidisciplinary study of arrhythmogenic right ventricular cardiomyopathy.
        Eur Heart J. 2015; 36: 1735-1743
        • Ommen S.
        • Mital S.
        • Burke M.A.
        • et al.
        AHA/ACC clinical practice guideline: 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy.
        Circulation. 2020; 142: e588-e631
        • Konhilas J.
        • Watson P.A.
        • Maass A.
        • et al.
        Exercise can prevent and reverse the severity of hypertrophic cardiomyopathy.
        Circ Res. 2006; 98: 540-548
        • Johnson J.N.
        • Ackerman Michael J.
        Return to play? Athletes with congenital long QT syndrome.
        Br J Sports Med. 2013; 47: 28-33
        • Ostby S.
        • Bos J.M.
        • Owen H.J.
        • et al.
        Competitive sports participation in patients with catecholaminergic polymorphic ventricular tachycardia: a single center's early experience.
        JACC Clin Electrophysiol. 2016; 2: 253-262
        • Kurtzwald-Josefson E.
        • Hochhauser E.K.
        • Guy P.E.
        • et al.
        Exercise training improves cardiac function and attenuates arrhythmia in CPVT mice.
        J Appl Physiol. 2012; 113: 1677-1683
        • Manotheepan R.
        • Saberniak J.
        • Danielsen T.K.
        • et al.
        Effects of Individualized exercise training in patients with catecholaminergic polymorphic ventricular tachycardia type 1.
        Am J Cardiol. 2014; 113: 1829-1833
        • Kim J.
        • Malhotra R.
        • Chiampas G.
        • et al.
        Cardiac arrest during long-distance running races.
        N Engl J Med. 2012; 366: 130-140
        • Baggish A.
        • Battle R.W.
        • Beckerman J.G.
        • et al.
        Sports cardiology: core curriculum for providing cardiovascular care to competitive athletes and highly active people.
        J Am Coll Cardiol. 2017; 70: 1902-1918
        • Wilkoff B.
        • Hess M.
        • Young J.
        • et al.
        Differences in tachyarrhythmia detection and implantable cardioverter defibrillator therapy by primary or secondary prevention indication in cardiac Resynchronization therapy patients.
        J Cardiovasc Electrophysiol. 2004; 15: 1002-1009
        • Investigators TAvIDA
        A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients Resucitated from Near-fatal ventricular arrhythmias.
        N Engl J Med. 1997; 337: 1576-1583A
        • Investigators T.C.
        Canadian implantable defibrillator study (CIDS)A Randomized trial of the implantable cardioverter defibrillator against amiodarone.
        Circulation. 2000; 101: 1297-1302
        • Ruwald M.
        • Ruwald A.-C.
        • Johanse J.B.
        • et al.
        Temporal incidence of appropriate and inappropriate therapy and mortality in secondary prevention ICD patients by cardiac diagnosis.
        JACC Clin Electrophysiol. 2021; 7: 781-792
        • Maron B.
        • Zipes D.P.
        • Kovacs R.J.
        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.
        Circulation. 2015; 132: e256-e261
        • Ackerman M.
        • Zipes D.P.
        • Kovacs R.J.
        • et al.
        Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 10: the cardiac channelopathies.
        Circulation. 2015; 132: e326-e329
        • Heidbuchel H.
        • Arbelo E.
        • D'Ascenzi F.
        • et al.
        Recommendations for participation in lesiure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part 2: ventricular arrhythmias, channelopathies and implantable defibrillators.
        Eur Soc Cardiol. 2021; 23: 147-148
        • Pelliccia A.
        • Sharma S.
        • Gati S.
        • et al.
        2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease.
        Eur Soc Cardiol. 2021; 42: 17-96
        • Lampert R.
        • Zipes D.P.
        Updated recommendations for athletes with heart disease.
        Annu Rev Med. 2018; 69: 177-189
        • Naik A.
        • Kallen M.A.
        • Walder A.
        • et al.
        Improving hypertension control in diabetes mellitus: the effects of collaborative and proactive health communication.
        Circulation. 2008; 117: 1361-1368
        • Wilson S.R.
        • Strub P.
        • Buist A.S.
        • et al.
        And the better outcomes of asthma treatment (BOAT) study group. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma.
        Am J Respir Crit Care Med. 2010; 181: 566-577
        • Stacey D.
        • Légaré F.
        • Col N.F.
        • et al.
        Decision aids for people facing health treatment or screening decisions.
        Cochrane Database Syst Rev. 2017; : CD001431
        • Shapero K.
        • Gier
        • Chad
        • et al.
        Experiences of athletes with arrhythmogenic cardiac conditions in returning to play.
        Heart Rhythm, 2022
        • Nash D.
        • Lee H.-R.
        • Janson C.
        • et al.
        Video game ventricular tachycardia: the "Fortnite" phenomenon.
        Heart Rhythm Case Rep. 2020; 6: 313-317
        • Alkharaza A.
        • Al-Harbi M.
        • El-sokkari I.
        • et al.
        The effect of revascularization on mortality and risk of ventricular arrhythmia in patients with ischemic cardiomyopathy.
        BMC Cardiovasc Disord. 2020; 20
        • De Ferrari G.
        • Dusi V.
        • Spazzolini C.
        • et al.
        Clinical management of catecholaminergic polymorphic ventricular tachycardia: the role of left cardiac sympathetic denervation.
        Circulation. 2015; 131: 2185-2193
        • Moss A.
        • Schuger C.
        • Beck C.A.
        • et al.
        Reduction in inappropriate therapy and mortality through ICD programming.
        N Engl J Med. 2012; 367: 2275-2283
        • Kutyifa V.
        • Daubert J.P.
        • Schuger C.
        • et al.
        Novel ICD programming and inappropriate ICD therapy in CRT-D versus ICD patients: a MADID-RIT sub-study.
        Circ Arrhythmia Electrophysiol. 2016; 9
        • Olshansky B.
        • Atteya G.
        • Cannom D.
        • et al.
        Competitive athletes with implantable cardioverter–defibrillators—how to program? Data from the implantable cardioverter–defibrillator sports registry.
        Heart Rhythm. 2019; 16: 581-587
        • Slotwiner D.
        • Varma N.
        • Akar J.G.
        • et al.
        HRS Expert Consensus Statement on remote interrogation and monitoring for cardiovascular implantable electronic devices.
        Heart Rhythm. 2015; 12: e69-e100
        • Knops R.
        • Nordkamp O.
        • Delnoy P.P.H.M.
        • et al.
        Subcutaneous or transvenous defibrillator therapy.
        N Engl J Med. 2020; 383: 526-536
        • Schneider A.
        • Burkhart H.M.
        • Ackerman M.J.
        • et al.
        Minimally invasive epicardial implantable cardioverter-defibrillator placement for infants and children: an effective alternative to the transvenous approach.
        Heart Rhythm. 2016; 13: 1905-1912
        • Parsons J.
        • Anderson S.A.
        • Casa D.J.
        • et al.
        Preventing catastrophic injury and death in collegiate athletes: Interassociation recommendations endorsed by 13 medical and sports medicine Organisations.
        J Athletic Train. 2019; 54: 843-851