New Guidance on Athletes with Arrhythmic Conditions Emphasizes Expert-Guided Management and Shared Decision-Making Approach to Facilitate Return to Play

Boston, MA, May 17, 2023 – Today, the Heart Rhythm Society (HRS) released a new expert consensus statement on the management of arrhythmias in athletes. The 2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play is a comprehensive resource designed to guide healthcare professionals in effectively diagnosing, treating, and managing arrhythmic conditions in athletes, facilitating return to sports while minimizing the harm caused by restrictions.

The field of sports cardiology is rapidly evolving, driven by increased athletic participation, heightened awareness of athletes' heart health, and recent cardiac events in high profile athletes. Understanding cardiac care for athletes requires specialized expertise in understanding the interaction of physical activity, sports-specific factors, normal cardiac adaptation to exercise, and arrhythmic conditions.

Participation in sports provides extensive physical and psychological benefits. Restricting athletes from participating can significantly harm their psychological well-being and quality of life. "Efforts to facilitate an athlete's safe return to sports, while not always achievable, should be pursued through thorough risk assessment, tailored management of their arrhythmic conditions, and a commitment to equitable care for all athletes," notes Rachel Lampert, MD, FHRS from the Yale University School of Medicine, and Chair of the consensus statement. Furthermore, arrhythmia treatment decisions should involve the athlete and other key stakeholders in shared decision-making, especially since these decisions are often influenced by the athlete's desire to return to sports. "Shared decision-making in athletes with arrhythmias is a collaborative process that balances the athlete's goals and preferences with input from their family, treating physicians, team physicians, sports cardiologists, and other institutional stakeholders, ensuring a comprehensive understanding and acceptance of the risks involved in return-to-play decisions," explains Eugene H. Chung, MD, MPH, MSc, FHRS from Massachusetts General Hospital and Harvard Medical School, and Vice Chair of the consensus statement.

The expert consensus statement provides evidence-based recommendations that impact all areas of care for athletes with arrhythmic conditions, reflecting the latest evidence and standards of care. It emphasizes the importance of expert, disease-specific risk assessments; personalized, athlete-focused management strategies; and careful evaluation of the risks and benefits of continued sports participation. The consensus statement highlights the importance of considering athletic performance when making decisions about treatment options, whether it be medication, ablation, or device implantation. The authors note that, while the data on athletes are still emerging, for many arrhythmogenic conditions, data have not confirmed increased risk of life-threatening arrhythmias from continued sports participation for those who are properly assessed and treated. Thus, the return-to-play approach should be one of individualized shared decision-making. The consensus document also emphasizes the fundamental need for venue-based and individualized emergency action plans (including plans for early defibrillation) to improve survival from sudden cardiac arrest.

The consensus statement is a result of an international collaboration between recognized experts across the fields of adult and pediatric electrophysiology, genetic cardiology, sports cardiology, sports medicine, and clinical research science. The consensus statement was developed in collaboration with the American College of Cardiology, the American Heart Association, the American Medical Society for Sports Medicine, the Asia Pacific Heart Rhythm Society, the European Heart Rhythm Association, the Latin American Heart Rhythm Society, and the Pediatric and Congenital Electrophysiology Society.

The consensus statement will be published in Heart Rhythm and its release will coincide with a session at Heart Rhythm 2024 in Boston―a premier event gathering heart rhythm professionals from around the world to advance the field of electrophysiology and improve patient outcomes through the exchange of groundbreaking science, innovative technologies, and life-saving therapies.

Funding: This expert consensus statement was developed without commercial support; the authors volunteered their time to the writing and review efforts.

Disclosures: Please see the article for a full list of author and peer reviewer disclosures.

Additional Resources

• After May 17, 2023, view the manuscript online in Heart Rhythm
• The document will be presented at Heart Rhythm 2024 during the session "The 2024 HRS Expert Consensus Statement on Arrhythmias in the Athlete: Evaluation, Treatment, and Return to Play" on May 17, 2024 at 2:30 pm ET
• The consensus statement was developed in accordance with HRS Clinical Document Development Methodology Manual and Policies

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