Recommendations for participation in competitive sport in adolescent and adult athletes with Congenital Heart Disease (CHD): position statement of the Sports Cardiology & Exercise Section of the European Association of Preventive Cardiology (EAPC), the European Society of Cardiology (ESC) Working Group on Adult Congenital Heart Disease and the Sports Cardiology, Physical Activity and Prevention Working Group of the Association for European Paediatric and Congenital Cardiology (AEPC)

Werner Budts^{1

2}, Guido E Pieles³, Jolien W Roos-Hesselink⁴, Maria Sanz de la Garza⁵, Flavio D'Ascenzi⁶, George Giannakoulas⁷, Jan Müller⁸, Renate Oberhoffer⁸, Doris Ehringer-Schetitska⁹, Vesna Herceg-Cavrak¹⁰, Harald Gabriel¹¹, Domenico Corrado¹², Frank van Buuren¹³, Josef Niebauer¹⁴, Mats Börjesson¹⁵, Stefano Caselli¹⁶, Peter Fritsch¹⁷, Antonio Pelliccia¹⁸, Hein Heidbuchel¹⁹, Sanjay Sharma²⁰, A Graham Stuart³, Michael Papadakis²⁰

Affiliations

¹ Department of Congenital and Structural Cardiology, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, B- 3000 Leuven, Belgium.
² Department of Cardiovascular Sciences, Catholic University Leuven, Campus Gasthuisberg, Herestraat 49, B- 3000 Leuven, Belgium.
³ National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Upper Maudlin Street, Bristol BS2 8BJ, UK.
⁴ Department of Cardiology, Erasmus University Medical Centre, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
⁵ Cardiovascular Institute, Hospital Clinic, Calle Villarroel, 170, 08036 Barcelona, Spain.
⁶ Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy.
⁷ Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Stilp. Kiriakidi 1, 546 37 Thessaloniki, Greece.
⁸ Department of Sport and Health Sciences, Institute of Preventive Pediatrics, German Heart Center, Technical University Munich, Georg-Brauchle-Ring 60/62 80992 München, Germany.
⁹ Department of Pediatrics and Adolescent Medicine, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700 Wiener Neustadt, Austria.
¹⁰ Pediatric Cardiology Department, Faculty of Dental Medicine and Health Osijek, Children's Hospital Zagreb, Libertas International University and University of Applied Health Sciences, Klaićeva 16, 10000 Zagreb, Croatia.
¹¹ Department of Cardiology, Medical University of Vienna/General Hospital Vienna, 1090 Wien, Währinger Gürtel 18-20, 1090 Vienna, Austria.
¹² Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Via Giustiniani 2, 35121 Padova, Italy.
¹³ Department of Internal Medicine, Catholic Hospital Southwestfalia-St. Martinus-Hospital Olpe, Angiology and Intensive Care Unit, Hospitalweg 6, 57462 Olpe, Germany.
¹⁴ University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria.
¹⁵ Department of Neuroscience and Physiology, Sahlgrenska Academy and Center for Health and Performance, Göteborg University and Sahlgrenska University Hospital/Ostra, Medicinaregatan 11-13, 413 90 Göteborg, Sweden.
¹⁶ Cardiovascular Center Zurich, Hirslanden Klinik im Park, Seestrasse 220, 8027 Zürich, Switzerland.
¹⁷ Institute for Paediatric Cardiology, University of Graz, Auenbruggerplatz 34/2, 8036 Graz, Austria.
¹⁸ Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197 Rome, Italy.
¹⁹ Department of Cardiology, Antwerp University and Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.
²⁰ Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, Blackshaw Rd, Tooting, London SW17 0QT, UK.

PMID: 32845299
DOI: 10.1093/eurheartj/ehaa501

Practice Guideline

Recommendations for participation in competitive sport in adolescent and adult athletes with Congenital Heart Disease (CHD): position statement of the Sports Cardiology & Exercise Section of the European Association of Preventive Cardiology (EAPC), the European Society of Cardiology (ESC) Working Group on Adult Congenital Heart Disease and the Sports Cardiology, Physical Activity and Prevention Working Group of the Association for European Paediatric and Congenital Cardiology (AEPC)

Werner Budts et al. Eur Heart J. 2020.

. 2020 Nov 14;41(43):4191-4199.

doi: 10.1093/eurheartj/ehaa501.

Authors

Affiliations

¹ Department of Congenital and Structural Cardiology, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, B- 3000 Leuven, Belgium.
² Department of Cardiovascular Sciences, Catholic University Leuven, Campus Gasthuisberg, Herestraat 49, B- 3000 Leuven, Belgium.
³ National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Upper Maudlin Street, Bristol BS2 8BJ, UK.
⁴ Department of Cardiology, Erasmus University Medical Centre, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
⁵ Cardiovascular Institute, Hospital Clinic, Calle Villarroel, 170, 08036 Barcelona, Spain.
⁶ Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy.
⁷ Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Stilp. Kiriakidi 1, 546 37 Thessaloniki, Greece.
⁸ Department of Sport and Health Sciences, Institute of Preventive Pediatrics, German Heart Center, Technical University Munich, Georg-Brauchle-Ring 60/62 80992 München, Germany.
⁹ Department of Pediatrics and Adolescent Medicine, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700 Wiener Neustadt, Austria.
¹⁰ Pediatric Cardiology Department, Faculty of Dental Medicine and Health Osijek, Children's Hospital Zagreb, Libertas International University and University of Applied Health Sciences, Klaićeva 16, 10000 Zagreb, Croatia.
¹¹ Department of Cardiology, Medical University of Vienna/General Hospital Vienna, 1090 Wien, Währinger Gürtel 18-20, 1090 Vienna, Austria.
¹² Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Via Giustiniani 2, 35121 Padova, Italy.
¹³ Department of Internal Medicine, Catholic Hospital Southwestfalia-St. Martinus-Hospital Olpe, Angiology and Intensive Care Unit, Hospitalweg 6, 57462 Olpe, Germany.
¹⁴ University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria.
¹⁵ Department of Neuroscience and Physiology, Sahlgrenska Academy and Center for Health and Performance, Göteborg University and Sahlgrenska University Hospital/Ostra, Medicinaregatan 11-13, 413 90 Göteborg, Sweden.
¹⁶ Cardiovascular Center Zurich, Hirslanden Klinik im Park, Seestrasse 220, 8027 Zürich, Switzerland.
¹⁷ Institute for Paediatric Cardiology, University of Graz, Auenbruggerplatz 34/2, 8036 Graz, Austria.
¹⁸ Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197 Rome, Italy.
¹⁹ Department of Cardiology, Antwerp University and Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.
²⁰ Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, Blackshaw Rd, Tooting, London SW17 0QT, UK.

PMID: 32845299
DOI: 10.1093/eurheartj/ehaa501

Abstract

Improved clinical care has led to an increase in the number of adults with congenital heart disease (CHD) engaging in leisure time and competitive sports activities. Although the benefits of exercise in patients with CHD are well established, there is a low but appreciable risk of exercise-related complications. Published exercise recommendations for individuals with CHD are predominantly centred on anatomic lesions, hampering an individualized approach to exercise advice in this heterogeneous population. This document presents an update of the recommendations for competitive sports participation in athletes with cardiovascular disease published by the Sports Cardiology & Exercise section of the European Association of Preventive Cardiology (EAPC) in 2005. It introduces an approach which is based on the assessment of haemodynamic, electrophysiological and functional parameters, rather than anatomic lesions. The recommendations provide a comprehensive assessment algorithm which allows for patient-specific assessment and risk stratification of athletes with CHD who wish to participate in competitive sports.

Keywords: Competitive sports; Congenital heart disease; Participation recommendations; Sports cardiology.

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