Table 2.
Current recommendations regarding athletic participation for athletes with cardiac conditions causing sudden death in young athletes
| Diagnosis | Recommendation | |
| HCM | 1 | Should not participate in most competitive sports with the possible exception of those of low intensity |
| 2 | Older athletes may participate depending on risk factor stratification | |
| ARVC | Should not participate in competitive sports | |
| Coronary artery anomalies | 1 | Should be excluded from competitive sports |
| 2 | Athletes without ischaemia on exercise stress testing may participate in sports >6 months after surgical treatment | |
| WPW | 1 | Athletes without structural heart disease, palpitations or tachycardia can participate in all competitive sports |
| 2 | Athletes with re-entrant tachycardia should be treated with radiofrequency ablation | |
| 3 | Athletes with atrial flutter/fibrillation with slow accessory pathway conduction and no syncope can participate freely. Those with syncope or fast accessory pathway conduction should be treated with radiofrequency ablation | |
| 4 | Athletes with successful ablation of accessory pathway who are asymptomatic, have normal atrioventricular conduction on electrophysiological study, and have no recurrence of tachycardia for 3–6 months can participate in all sports | |
| Ion channelopathies* | Should not participate in competitive sports | |
| IDCM | Should not participate in competitive sports | |
| Premature coronary artery disease | 1 | If considered low risk†, can participate in low and moderate intensity sports. Should be re-evaluated annually |
| 2 | If considered to be at high risk†, may only participate in low intensity sports. Should be re-evaluated every 6 months | |
| Marfan’s syndrome | 1 | Athletes without a family history of premature sudden cardiac death and without aortic root dilatation can participate in low and moderate intensity competitive sports. Serial 6 monthly monitoring of aortic root should be repeated |
| 2 | Athletes with aortic root dilatation can participate in low intensity sports only | |
| Myocarditis | 1 | Should be withdrawn from competitive sports for about 6 months after onset of symptoms for convalescence |
| 2 | May return to competitive sports after normalisation of ventricular function and absence of clinically relevant arrhythmias on ambulatory ECG monitoring | |
| Aortic stenosis | 1 | Athletes with mild aortic stenosis (<20 mm Hg) can participate in all competitive sports |
| 2 | Athletes with mild to moderate aortic stenosis (21 to 40 mm Hg) can participate in all low intensity sports. Some, depending on exercise stress testing, can participate in low and moderate intensity sports | |
| 3 | Athletes with severe aortic stenosis (>40 mm Hg) or symptoms should not engage in any competitive sports | |
| 4 | Athletes with bicuspid aortic valve, even without stenosis but with aortic dilatation, can participate in low intensity sports only. Serial 6 monthly echocardiographic monitoring of aortic root and ascending aorta is recommended | |
ARVC, arrhythmogenic right ventricular cardiomyopathy; HCM, hypertrophic cardiomyopathy; IDCM, idiopathic dilated cardiomyopathy; WPW, Wolff-Parkinson-White syndrome.
*Long QT and Brugada syndromes.
†Low risk defined by normal systolic function, normal exercise tolerance for age, no ischaemia on exercise stress testing, no exercise induced complex ventricular arrhythmia, and no haemodynamically significant coronary artery stenosis.