Restricting sports for athletes with heart disease: are we saving lives, avoiding lawsuits, or just promoting obesity and sedentary living?

Sudden cardiac death in young competitive athletes is tragic and usually due to unsuspected cardiovascular disease. Screening programs for athletes remain debatable, and restriction of athletes from sports can have physical, emotional, and legal ramifications. In this article, we review the epidemiology of the more common inherited arrhythmias and congenital heart diseases that are of concern in a newly diagnosed athlete. A comparison of the current American Heart Association/American College of Cardiology and European Society guidelines, which are primarily based on expert opinion due to lack of randomized studies, is then undertaken. Furthermore, certain legal repercussions associated with both qualifying and restricting athletes from competitive sports are discussed. Lastly, we urge physicians to keep in mind that disqualifying an athlete from competitive sports does not mean restriction of all activities, and even patients with inherited arrhythmias and congenital heart disease can participate in low to moderate activity complementary with a healthy lifestyle.