Table 3. Comparison of U.S. And European Guidelines for Preparticipation Screening for Competitive Sports.
136th Bethesda Conference; 2European Society of Cardiology Conference; 3U.S. strategy for high school and collegiate athletes; 4Italian screening model a Exceptions: low static and low dynamic intensity sports such as golf; b Class IA and IIA: low and moderate static/low dynamic competitive sports. Cannot have one or more of following: aortic root dilatation ≥40mm in adults or more than 2 SDs from the mean for body surface in children, moderate to severe mitral regurgitation, family history of dissection or sudden death in Marfan relative; c Independent of aortic root dimension; d EPS advisable in moderate or high level competitive sports CV - cardiovascular; ECG - electrocardiogram; EPS - electrophysiologic study; HCM - hypertrophic cardiomyopathy; ICD - implantable cardioverter-defibrillator; LQTS - long QT syndrome; NSVT – non-sustained ventricular tachycardia; PVC - premature ventricular complex; RFA - radiofrequency ablation; WPW - Wolff Parkinson white syndrome
| Condition | 1U.S. Recommendations | 2European Recommendations |
|---|---|---|
| HCM | a Exclude from most sports | a Exclude from most sports |
| Genotype + Phenotype - | No data to exclude | Participation only in noncompetitive or leisure-time sporting activities |
| Marfan Syndrome | b Restricted to class IA and IIA sports | c Exclude from all sports |
| Long QT Syndrome | ≥470ms (men); ≥480ms (women) | ≥440ms for men; ≥460ms (women) |
| Restriction to low intensity sports | Exclude from all sports | |
| Genotype + Phenotype - | No exclusion | Discouraged participation in sports |
| LQT1 genotype: refrain from competitive swimming | ||
| Brugada Syndrome | Restriction to low intensity sports | Exclude from all sports |
| Genotype + Phenotype - | No exclusion | Exclude from all sports |
| Ventricular pre-excitation | d Asymptomatic: EPS not mandatory | Asymptomatic: EPS mandatory |
| (WPW Syndrome) | Symptomatic: EPS required | Symptomatic: EPS mandatory |
| Return after RFA: 4 weeks | Return after RFA: 3 months | |
| PVC | No restriction unless PVCs increase with exercise, then restriction to low intensity sports | |
| NSVT | No CV disease: No exclusion | No CV disease: No exclusion |
| CV disease: restricted to low intensity sports | CV disease: restricted to recreational sports | |
| ICD | Exclude from competitive sports | Exception: sports without associated risk of trauma to the device |
| Screening | [3]Medical history + physical exam | [4]12 lead ECG + medical history + physical exam |
| Perform screening | Physician volunteers | Sports medicine physicians |
| Healthcare workers | ||
| Authority for disqualification | High school or college officials | Sports medicine physician |