Safely Getting Athletes with Heart Rhythm Issues Back in the Game

Understanding Arrhythmias in Athletes

When an athlete is diagnosed with a heart rhythm problem, also known as an arrhythmia, it can significantly impact their sports participation. Arrhythmias happen when the electrical signals that control heartbeats are not functioning correctly. This can cause the heart to beat too fast, too slow, or irregularly.

The return-to-play decision for athletes with arrhythmias must be personalized. It's important to assess the risks and provide appropriate treatment before allowing them to resume their activities. This approach, highlighted in a recent expert statement, emphasizes the importance of a shared decision-making process involving both the athlete and healthcare provider.

Expert Consensus on Safe Return to Sports

The Heart Rhythm Society recently released a comprehensive guideline on the evaluation, treatment, and return to play for athletes with arrhythmias. These guidelines were presented at Heart Rhythm 2024 and published in the journal HeartRhythm. Recent studies show that with proper management and treatment, continuing sports does not necessarily increase the risk for athletes with heart conditions.

One of the key messages from the guidelines is shifting the focus from questioning whether an athlete can return to play to how to best manage their condition to enable them to return to their sport. Dr. Rachel Lampert from Yale School of Medicine emphasizes that the goal is to get athletes back to their favorite activities by optimizing their heart condition management.

Comprehensive Evaluation for Sports Participation

A thorough evaluation of athletes with arrhythmias should be conducted by experienced clinicians who understand how the heart adapts to the physical demands of different sports. This evaluation often includes stress tests to see how the heart performs under physical exertion and to reproduce any symptoms that may occur during sports activities.

Such stress tests are essential before an athlete can return to play. The tests help ensure that the arrhythmias are under control and that the athlete can safely participate in their chosen sport without significant risks.

Individualized Management Plans

The treatment and management plan for athletes with arrhythmias should consider how the condition or its treatment might affect their performance. Personalized plans should take into account the specific sport, the athlete's goals, and preferences to achieve safe and effective management of their condition.

Physicians play a crucial role in helping athletes understand their condition, risks, and existing data. The shared decision-making process involves discussing the options for managing arrhythmias to help athletes meet their goals. Specific recommendations are provided for different situations and for determining when it is safe to return to play.

Emergency Action Plans

Having a venue-based action plan is critical for the survival of athletes who might experience sudden cardiac arrest during sports. Any athlete who collapses and is unresponsive should be assumed to have had a sudden cardiac arrest and treated accordingly. Immediate action and readiness can save lives.

Additionally, periodic evaluations are recommended to screen for risks associated with sudden cardiac death. Athletes who are at higher risk and are returning to play should have a personalized emergency action plan tailored to their needs.

Addressing Knowledge Gaps

While the guidelines provide a solid framework for managing arrhythmias in athletes, there are still knowledge gaps that need addressing. For instance, the ideal procedures for evaluating an athlete who loses consciousness during exercise, the impact of race, ethnicity, and gender on arrhythmic conditions, and the best strategies for anticoagulation therapy in athletes remain areas requiring further research.

By addressing these gaps, healthcare providers can better support athletes with arrhythmias and help them safely return to their sports activities.