Italian Guidelines for Competitive Athletes with Arrhythmias

Abstract

In Italy, participation in a competitive sport is regulated by special national and regional laws concerning preparticipation medical screening. Italian legislation is based on a tradition that limits the free will in situations that could endanger human life. In the last few years, new laws concerning Italian sports have been introduced because of the wide resonance caused by the sudden deaths of some top-level athletes. The most important Italian law concerning the health of athletes stipulates that they must undergo a medical evaluation, including some examinations (resting and Montoye step-test electrocardiogram, spirometry and urine test). Consequently, every athlete without clinical problems must be in possession of a sports eligibility certificate issued by a sports medicine physician. The sports medicine physician is legally responsible for accidents that could occur during an athlete’s career and can be charged with medical malpractice (incorrect risk assessment, etc.). Furthermore, the sports medicine physician shares the responsibility with other specialists and consultants, most of whom are cardiologists. The cardiologist is a very important consultant, since lack of eligibility is most commonly due to cardiovascular diseases (50–80%). Therefore, the Italian cardiological guidelines for sports activity make physicians indispensable for sports medicine. These guidelines were published in 1989 and 1995 and were based on the opinions of sports medicine authorities, indicated by the five major scientific cardiological and sports medicine Italian societies (the Italian Hospital Cardiologists’ Association, the Italian Non-Hospital Cardiologists’ Association, the Italian Society of Cardiology, the Italian Society of Sports Cardiology and the Italian Sports Medicine Federation) (1, 2). Although the Italian guidelines took into account the conclusions of the Bethesda Conference (3, 4), some important differences between the two protocols exist. In the USA, athletes can settle disagreements about their physical health while in Italy, the physician has the sole responsibility. Therefore, for the same cardiovascular anomalies, the Italian guidelines are often more restrictive than the US ones (5). The two guidelines agree on some arrhythmic conditions (coronary artery disease, hypertrophic cardiomyopathy, long QT syndrome, myocarditis, etc). However, there are important differences concerning other arrhythmias, such as Wolff-Parkinson-White syndrome and ventricular arrhythmias.