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Sports_AVB_complete_congen_Overview.html
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<!DOCTYPE html>
<html lang="en">
<!-- defines the default zoom for mobile devices -->
<meta name="viewport" content="width=device-width, initial-scale=1" />
<head>
<meta charset="UTF-8">
<title>CardioRef: AHA/ACC 2015 Sports Participation Selector Guide: Congenital High-Grade or Complete AV Block</title>
<link rel="stylesheet" href="css/sports_answer_combined.css">
<style>
div{
-webkit-margin-before:0;
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</head>
<body>
<div class="topbar">
<a href="index.html">Pedi CardioRef</a>
<div class="guidelinebar">
<a target="_blank" rel="noopener noreferrer" href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000000245">
Reference: ACC/AHA Sports Participation Recommendations (Circulation 2015) Task Force 9: Arrhythmias and Conduction Defects</a>
</div>
</div>
<section style="margin:10px">
<p class="topspace"></p>
<label><b>By the ACC/AHA 2015 guidelines, should my patient with</label>
<select name="disease" id="dz" class="InputBox" onChange="goThere();">
<option value="">*Select Disease*</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="HCM">Hypertrophic Cardiomyopathy </option>
<option value="LVNC">Left Ventricular Non-Compaction </option>
<option value="DilRestr">Dilated or Restrictive Cardiomyopathy </option>
<option value="ARVC">Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) </option>
<option value="Myo">Myocarditis </option>
<option value="Peri">Pericarditis </option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="ASDVSDPDA">ASD, VSD, or PDA </option>
<option value="PS">Pulmonic Stenosis </option>
<option value="AS">Aortic Stenosis </option>
<option value="Coarct">Coarctation </option>
<option value="Cyan">Cyanotic Heart Disease, unrepaired or with palliative shunt </option>
<option value="TOF">Tetralogy of Fallot, s/p repair </option>
<option value="TGA_Must">d-transposition (d-TGA), s/p atrial switch (Mustard/Senning)</option>
<option value="TGA_Art">d-transposition (d-TGA), s/p arterial switch </option>
<option value="CCTGA">Congenitally-corrected TGA (CC-TGA, L-TGA)</option>
<option value="Fontan">Fontan </option>
<option value="Ebstein">Ebstein Anomaly </option>
<option value="AnomCoronary">Anomalous Coronary Artery Origin</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="PVR">Elevated PVR in CHD </option>
<option value="VentricularDysfxn">Ventricular Dysfunction s/p CHD Surgery</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="Valve_AS">Aortic Stenosis</option>
<option value="Valve_AR">Aortic Regurgitation </option>
<option value="Valve_MS">Mitral Stenosis</option>
<option value="Valve_MR">Mitral Regurgitation </option>
<option value="Valve_Hx">History of Mitral or Aortic Valve Surgery</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="HTN">Hypertension </option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="AoDiseases_and_Marfan">Aortic Diseases and Marfan Syndrome</option>
<option value="BAV">Bicuspid Aortic Valve</option>
<option value="Marfan">Marfan Syndrome</option>
<option value="TAA">Thoracic Aortic Aneurysm, familial or unexplained</option>
<option value="LoeysDietz_EhlersDanlos">Loeys-Dietz or vascular Ehlers-Danlos</option>
<option value="AoEnlarge">Enlarged Aorta, non-syndrome non-familial</option>
<option value="Ao_Surgery">S/p Surgery for Aortic Enlargement/Dissection</option>
<option value="Chronic_AoDissection">Chronic Aortic Dissection or Branch Aneurysm</option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="CoronaryOverview">Coronary Artery Disease </option>
<option value ="" class="dropdown-divider">---------------------------------------------------------------</option>
<option value="Syncope">Syncope </option>
<option value="Arrhythmia">Arrhythmias (SVT, PVC, Vtach, etc.) </option>
<option value="ConductionDefect">Conduction Defects (AV block, brady, pacemaker, RBBB/LBBB)</option>
<option value="Channelopathies">Channelopathies (LQTS, CPVT, Brugada, etc.) </option>
<option value="ICD">Implantable Cardioverter-Defibrillator (ICD) </option>
</select>
<span>participate in organized sports?</span></b>
<br><br>
<section id="question">
Should my patient with <b>Congenital High-Grade or Complete AV Block</b> participate in organized sports?
</section>
</section>
<!-- End of 10px margin section. Consider changing template. -->
<br>
<!-- navigation bar for disease sub-categories -->
<nav>
<a href="Sports_Pacemaker_Overview.html">Permanent pacemaker</a>
<a href="Sports_SinusBrady_Overview.html">Sinus bradycardia</a>
<a href="Sports_AVB_1_Overview.html">1st-degree AV block</a>
<a href="Sports_AVB_2_Type1_Overview.html">2nd-degree AV block, Type 1 (Wenckebach)</a>
<a href="Sports_AVB_2_Type2_Overview.html">2nd-degree AV block, Type 2</a>
<a href="Sports_AVB_complete_congen_Overview.html" class="active">Congenital high-grade or complete AV block</a>
<a href="Sports_AVB_complete_acquired_Overview.html">Acquired complete AV block</a>
<a href="Sports_RBBB_Overview.html">Complete RBBB</a>
<a href="Sports_LBBB_Overview.html">Complete LBBB</a>
</nav>
<div class="largeanswerbox">
<h2 align="center"><u>Congenital</u> High-Grade or Complete AV Block</h2>
<hr>
<section id="needtoknow">
<p class="sectiontitle">Need to know:</p>
<ul>
<li>Junctional escape, and QRS duration</li>
<li>Resting ventricular rate</li>
<li>Structural heart disease?</li>
<li>Symptomatic?</li>
</ul>
</section>
<section id="answer">
<section id="answer_arrow_section">
<section class="third_invisible">⇙ </section>
<section class="third_invisible">⇓</section>
<section class="third_invisible">⇘</section>
</section>
<section class="third_left">
<p class="sectiontitle">Asymptomatic, junctional escape QRS < 120, resting ventricular rate > 40 bpm that augments, good exercise capacity</p>
<p>"Asymptomatic athletes without heart disease who have a junctional escape rhythm that has a QRS duration < 120 ms,
resting ventricular rates >40 bpm that increase appropriately with exertion, and exercise capacity
that approximates that of the relevant sport can participate in athletic activity without restriction."
</p>
<div class="verdict_ok"><b>No restrictions</b> if conditions met</div>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>
</section>
<section class="third_middle">
<p class="sectiontitle">Symptomatic, resting ventricular rate < 40 bpm, ventricular escape QRS >120</p>
<p>"Athletes with symptomatic heart block, resting ventricular rates < 40 bpm,
or ventricular escape rhythm with a QRS width >120 ms <b>should have a pacemaker implanted
before they participate in competitive sports.</b>
<br><br>
Before athletes are allowed to resume sports, an <b>exercise test</b> should be conducted to ensure patient safety
and that the exercise capacity of the athlete is similar to that required for the relevant sport."
</p>
<div class="verdict_no"><b>Should have pacemaker</b></div>
<p align="center" style="font-size: 20px">⇓</p>
<div class="verdict_maybe"><b>If has pacemaker, and exercise test results favorable, can resume sports</b></div>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>
</section>
<section class="third_right">
<p class="sectiontitle">Structural heart disease</p>
<p>"Athletes with structural heart disease and congenital complete heart block should be restricted from,
or allowed to participate in, competitive athletics based on the recommendations for
the type of structural heart disease with or without a permanent pacemaker."
</p>
<div class="verdict_maybe"><b>Based on structural heart disease</b></div>
<p class="rec_class">(Class I Recommendation; Level of Evidence C)</p>
</section>
</section>
</div>
<p class="foot">
<b>Reference:</b> <a href="https://www.ahajournals.org/doi/10.1161/CIR.0000000000000245"><i>Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 9: Arrhythmias and Conduction Defects.</a>
A Scientific Statement From the AHA and ACC. Circulation 2015</i>
<br><br><b>Disclaimer:</b> This website is derived from published guidelines, but does not constitute medical advice nor does it replace clinical judgement. Only the text in quotation marks are direct quotations from the original guidelines. Text not in quotations as well as the method of information display are all that of the website creator and are not part of the original published guidelines. Please consult a physician to discuss any patient-specific matters.
</p>
<section class="key">
<p><b>Key: AV = atrioventricular</b>
</p>
</section>
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