Michael S. Emery

International recommendations for electrocardiographic interpretation in athletes

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural, or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly over the last decade; pushed by a growing body of scientific data that both tests proposed criteria sets and establishes new evidence to guide refinements. On February 26-27, 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington, to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.

Interassociation Consensus Statement on Cardiovascular Care of College Student-Athletes

Cardiovascular evaluation and care of college student-athletes is gaining increasing attention from both the public and medical communities. Emerging strategies include screening of the general athlete population, recommendations of permissible levels of participation by athletes with identified cardiovascular conditions, and preparation for responding to unanticipated cardiac events in athletic venues. The primary focus has been sudden cardiac death and the utility of screening with or without advanced cardiac screening. The National Collegiate Athletic Association convened a multidisciplinary task force to address cardiovascular concerns in collegiate student-athletes and to develop consensus for an interassociation statement. This document summarizes the task force deliberations and follow-up discussions, and includes available evidence on cardiovascular risk, pre-participation evaluation, and the recognition of and response to cardiac arrest. Future recommendations for cardiac research initiatives, education, and collaboration are also provided.

International criteria for electrocardiographic interpretation in athletes: consensus statement

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26–27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.

Protecting the heart of the American Athlete: Proceedings of the American college of cardiology sports and exercise cardiology think tank October 18, 2012, Washington, DC

Yvette L. Rooks, MD, CAQ, FAAFP[1][1] G. Paul Matherne, MD, FACC[2][2] Jim Whitehead[3][3] Dan Henkel[3][3] Irfan M. Asif, MD[4][4] James C. Dreese, MD[5][5] Rory B. Weiner, MD[6][6] Barbara A. Hutchinson, MD, PhD, FACC[7][7] Linda Tavares, MS, RN, AACC[8][8] Steven Krueger, MD, FACC[9][9

The role of exercise in atrial fibrillation prevention and promotion: Finding optimal ranges for health

The cardiovascular benefits of regular exercise have been well described, including a significant reduction in cardiovascular morbidity and mortality for those meeting recommended guidelines. Yet the impact of physical activity on the incidence of atrial fibrillation (AF) has been less clear. This review seeks to define the optimal dose and duration for the prevention and treatment of AF. In doing so, we review the evidence that supports a decline in AF risk for those who achieve a weekly physical activity dose slightly above the current recommended guidelines. Furthermore, we identify the reduced AF incidence in those individuals who attain a cardiorespiratory fitness of 8 METs (metabolic equivalents of task) or more during maximal exercise testing. Finally, we review the evidence that shows an excess of AF among regular participants of endurance exercise.

Interassociation consensus statement on cardiovascular care of college student-athletes

Cardiovascular evaluation and care of college student-athletes is gaining increasing attention from both the public and medical communities. Emerging strategies include screening of the general athlete population, recommendations of permissible levels of participation by athletes with identified cardiovascular conditions and preparation for responding to unanticipated cardiac events in athletic venues. The primary focus has been sudden cardiac death and the usefulness of screening with or without advanced cardiac screening. The National Collegiate Athletic Association convened a multidisciplinary task force to address cardiovascular concerns in collegiate student-athletes, and to develop consensus for an interassociation statement. This document summarises the task force deliberations and follow-up discussions, and includes available evidence on cardiovascular risk, preparticipation evaluation and the recognition of and response to cardiac arrest. Future recommendations for cardiac research initiatives, education and collaboration are also provided.

AMERICAN HEART ASSOCIATION PREPARTICIPATION CARDIOVASCULAR SCREENING OF COMPETITIVE ATHLETES HISTORY ELEMENTS APPLIED TO A DIVERSE INTERNATIONAL SCREENING PROGRAM

Background: The history portion of the American Heart Association (AHA) preparticipation evaluation (PPE) consists of 7 personal & 3 family history questions. These were developed by expert opinion & have not been evaluated in a diverse international setting. Methods: At the 2015 Summer World

Reply: Exercise at the Extremes

We thank Dr. Niederseer and colleagues for their kind comments on our paper. We agree that endurance athletes live longer than their contemporaries, but doubt that pre-participation screening is responsible because the observation of longevity greatly predates the screening. The annual rate of

Reply: No Evidence for Femoral Pulse Evaluation in Normotensive College Athletes During Sports Preparticipation Examinations

Dr. McGrew makes an excellent point in questioning the rationale for evaluating the femoral pulse in normotensive college student-athletes during the preparticipation evaluation, noting that there have been no documented cases of sudden death in college athletes from coarctation of the aorta.

Consensus statement and guidelines: Interassociation consensus statement on cardiovascular care of college student-athletes

Cardiovascular evaluation and care of college student-athletes is gaining increasing attention from both the public and medical communities. Emerging strategies include screening of the general athlete population, recommendations of permissible levels of participation by athletes with identified cardiovascular conditions and preparation for responding to unanticipated cardiac events in athletic venues. The primary focus has been sudden cardiac death and the usefulness of screening with or without advanced cardiac screening. The National Collegiate Athletic Association convened a multidisciplinary task force to address cardiovascular concerns in collegiate student-athletes, and to develop consensus for an interassociation statement. This document summarises the task force deliberations and follow-up discussions, and includes available evidence on cardiovascular risk, preparticipation evaluation and the recognition of and response to cardiac arrest. Future recommendations for cardiac research initiatives, education and collaboration are also provided.