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Return to play in the athlete with cardiac disease: who decides and what is the protocol?
1Division of Cardiology,Children's Hospital Los Angeles,Keck School of Medicine,University of Southern California,Los Angeles,California,United States of America.
Insights
Developing return-to-play protocols for athletes with treated cardiovascular abnormalities is challenging due to limited data. This review examines ethical considerations and current practices for these athletes.
Area of Science:
- Sports Medicine
- Cardiology
- Medical Ethics
Background:
- Established return-to-play (RTP) protocols exist for concussion and orthopedic injuries.
- Criteria for disqualification/eligibility for athletes with congenital cardiovascular abnormalities are developing.
- Lack of specific RTP data for treated cardiovascular conditions complicates decision-making.
Purpose of the Study:
- To review current data and practices for RTP decisions in athletes with treated cardiovascular abnormalities.
- To discuss the ethical dilemmas faced by team physicians in RTP decisions.
- To highlight the role of cardiovascular consultants in managing these athletes.
Main Methods:
- Literature review of current data and practices.
- Discussion of ethical considerations for team physicians.
- Analysis of RTP recommendations for specific cardiovascular conditions.
Main Results:
- Inadequate data exists for developing specific RTP protocols for treated cardiovascular abnormalities.
- Team physicians face ethical conflicts between team goals and individual athlete welfare.
- Current RTP practices for conditions like supraventricular tachycardia ablation, device implantation, syncope, and genetic mutations are discussed.
Conclusions:
- Specific RTP protocols for treated cardiovascular abnormalities are needed.
- Clearer guidelines and collaboration between team physicians and cardiovascular consultants are essential.
- Recommendations provided serve as a starting point for evolving RTP decision-making.
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.
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