Clinical Research
Screening of Athletes
Bethesda Conference #36 and the European Society of Cardiology Consensus Recommendations Revisited: A Comparison of U.S. and European Criteria for Eligibility and Disqualification of Competitive Athletes With Cardiovascular Abnormalities

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Aspiration to reduce the risks of athletic field deaths prompted the American Heart Association and European Society of Cardiology (ESC) to establish consensus guidelines for eligibility/disqualification decisions in competitive athletes with cardiovascular abnormalities. Since 2005, the Bethesda Conference #36 and the ESC consensus documents have been relied upon by physicians from different parts of the world. The 2 consensus documents emanate from largely different cultural, social, and legal backgrounds existing in the U.S. and Europe and, although several recommendations are similar, in some instances the Bethesda Conference #36 and the ESC consensus documents suggest different approaches to disqualification decisions and implications for clinical practice, raising the possibility that confusion and discrepancies will contaminate the management of competitive athletes with cardiovascular disease. In the present article, the differences between the 2 documents are critically viewed, with special attention to genetic cardiovascular diseases relevant to sudden death in young athletes, through the prism of different cultural backgrounds, societal attitudes, and also perceptions regarding exposure to legal liability in the U.S. and Europe. In conclusion, it seems appropriate at some time to consider assembling updated recommendations for sports eligibility/disqualification that assimilate both the U.S. and European perspectives, with the aspiration of creating a unique and authoritative document applicable to the global sports medicine community.

Key Words

cardiovascular disease
competitive athletes
guidelines for eligibility/disqualification

Abbreviations and Acronyms

ACC
American College of Cardiology
BC#36
Bethesda Conference #36
CPVT
catecholaminergic polymorphic ventricular tachycardia
ECG
electrocardiogram
ESC
European Society of Cardiology
HCM
hypertrophic cardiomyopathy
ICD
implantable cardioverter-defibrillator
LQTS
long-QT syndrome
PVC
premature ventricular complex
QTc
QT interval corrected for heart rate
WPW
Wolff-Parkinson-White syndrome

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