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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

Antonio Pelliccia, MD^_*,_*, Douglas P. Zipes, MD and Barry J. Maron, MD

^_* Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome, Italy
Indiana University School of Medicine and Krannert Institute of Cardiology, Indianapolis, Indiana
The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota

Manuscript received April 18, 2008; revised manuscript received August 8, 2008, accepted August 11, 2008.

^_* Reprint requests and correspondence: Dr. Antonio Pelliccia, Institute of Sports Medicine and Science, Largo Piero Gabrielli 1, 00197 Rome, Italy (Email: antonio.pelliccia{at}coni.it).

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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