Bethesda Conference #36 and the European Society of Cardiology Consensus Recommendations Revisited
Open accessAbstract
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 au…
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Primary or secondary prevention of syncope, morbidity, and mortality in at-risk athletes is a major consideration, but current strategies are largely inadequate.
“Primary or secondary prevention of syncope, morbidity, and mortality in at-risk athletes is a major consideration, but current strategies are largely inadequate (706).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [706]
The current evidence base is insufficient to support general screening with ECG or echocardiography at baseline.
“The current evidence base is insufficient to support general screening with ECG or echocardiography at baseline (706,707).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [706]
Even supraventricular arrhythmias, such as rapidly conducted preexcited atrial fibrillation during exertion, can have potentially life-threatening haemodynamic consequences.
“because of potentially life-threatening haemodynamic consequences of even supraventricular arrhythmias, such as rapidly conducted preexcited atrial fibrillation during exertion”
From Management of patients with palpitations: a position paper from the European Heart Rhythm Association (2011) · cites this paper as [57]
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Self-citationDoes sports activity enhance the risk of sudden death in adolescents and young adults?
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Self-citation2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
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2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
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Exercise and sports participation in patients with thoracic aortic disease: a review
Thijssen, C. G. E., Bons, L. R., Gökalp, A. L., Van Kimmenade, R. R. J., Mokhles, M. M., Pelliccia, A., Takkenberg, J. J. M., & Roos-Hesselink, J. W. (2019) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2019.1585807 · Cited by 63 · see citing works
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- Authors
- Pelliccia, A., Zipes, D. P., & Maron, B. J.
- Affiliations
- National Research Council (IT)
- Indiana University Indianapolis (US)
- Minneapolis Heart Institute Foundation (US)
- Corresponding author
- Pelliccia, Antonio
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2008-12
- Volume
- 52
- Issue
- 24
- Pages
- 1990-1996
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W10601133
- Cited by
- 295
- References
- 3
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 10 · 2023: 8 · 2022: 9 · 2021: 7 · 2020: 11 · 2019: 10 · 2018: 16 · 2017: 28 · 2016: 20 · 2015: 30 · 2014: 14 · 2013: 23 · 2012: 30
- FWCI
- 16.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- sports eligibility, competitive athletes, legal liability, sports medicine guidelines
- MeSH terms
- Arrhythmias, Cardiac, Cardiomyopathy, Hypertrophic, Cardiovascular Diseases, Competitive Behavior, Europe, Humans, Marfan Syndrome, Mass Screening, Societies, Medical, Sports, Sports Medicine, United States, Consensus Development Conferences, NIH as Topic, Tachycardia, Ventricular, Risk Assessment, Ventricular Premature Complexes
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