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Sports Cardiology - Brugada and Exercise — EECC MCQ

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ModerateGeneral CardiologySports Cardiology - Brugada and ExerciseEECC

A 45-year-old man who plays county-level football collapses during a match and is resuscitated from ventricular fibrillation. He has a structurally normal heart on echocardiography and CMR, normal coronary arteries, and a normal resting ECG. An ajmaline provocation test reveals a type 1 Brugada ECG pattern. What are the ESC recommendations regarding return to competitive sport?

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Correct answer: D — Competitive sport is not recommended after a cardiac arrest due to Brugada syndrome, even with an ICD in situ

The 2020 ESC Sports Cardiology Guidelines recommend against competitive sport participation for patients with Brugada syndrome who have survived a cardiac arrest (secondary prevention), regardless of ICD implantation. The rationale is that hyperthermia, autonomic surges, and electrolyte changes during intense exercise can trigger arrhythmias. An ICD protects against SCD but does not eliminate risk, and ICD shocks during competition carry additional hazards. Low-intensity recreational exercise may be considered after shared decision-making. This is distinct from asymptomatic Brugada syndrome detected incidentally, where exercise restrictions are less stringent.

Reference: ESC (2020): Guidelines on Sports Cardiology and Exercise in Patients with Cardiovascular Disease